Sales of alcohol surged in 2020, especially among the higher-proof varieties. But one type far outsold the others: hand sanitizer. In the heat of the pandemic, Purell poured some $400 million into expanding its production. As anyone who resorted to bootleg hand sanitizer knows, the company came nowhere close to meeting demand. Distilleries and state governments also got in on the action; New York State’s version was, as best as I could discern, a mixture of urinal cakes and bottom-shelf vodka. (I was grateful for it.) All told, by the end of 2020, sales of hand sanitizer had increased by 600 percent. Some of this sanitizer is presumably still sitting untouched in people’s pandemic pantry stockpiles. But much of it also went onto our skin, where the alcohol hastily dissolves most of the viruses, bacteria, and fungi it encounters. This dramatic increase in personal sterilization—combined with many other microbe-reducing habits, including masking and physical distancing—have prompted some biologists to wonder, in academic papers and prominent op-eds, about the extent of the “collateral damage” to our immune system. To get this out of the way: Destroying the coronavirus is, without question, paramount. Millions of people are dead, and tens of thousands more die every week. At the same time, the majority of the trillions of microbes that inhabit our skin and gut—collectively, our microbiome—are either harmless or helpful. “The microbes we carry around are involved in many of the fundamental processes of Homo sapiens,” Brett Finlay, a professor of microbiology and immunology at the University of British Columbia, in Canada, told me. Among their other roles, these organisms interact with the immune cells in our skin and teach them to respond only to serious threats. The overall effect of messing with our microbes is not manifestly good or bad, but it is also manifestly not zero. Our microbiome is constantly in low-level flux, depending on our environment—the people around us, the food we eat, the soaps we use, and so on. But many of our environments and daily routines have changed dramatically over the past year as a result of the extreme focus on hygiene and potential viral exposures of all sorts. This has almost certainly had substantive effects on our microbiome diversity, individually and collectively, Finlay said. “The concern among some microbiologists, for the last decade or so, has been that the collateral damage of excessive sanitizing and use of antibiotics is not good, in terms of microbes that we spent thousands of years evolving with.” He cited links between antibiotic overuse and increasing rates of asthma and obesity, as well as a smattering of evidence about the beneficial effects of vaginal deliveries versus Cesarean sections. There is also evidence that having a diverse microbiome is an indicator—if not necessarily a driver—of good health. [Read: Why are your gut microbes different from mine?] The pandemic may have accelerated that loss of diversity. In recent weeks, Finlay has been quoted on the subject in several news stories, as concerned work-from-homers begin to reckon with the long-term effects of their extended isolation. “When COVID hit, it created a fantastic experiment that’s ongoing,” Finlay told me. “We have completely changed our behaviors, and when you do that, you change your microbial exposures: You’re not hugging and kissing people, not riding the subways; you’re spending more time at home making bread.” (How did he know?) It’s too early to be certain of the effects, Finlay said, and any correlations could take decades to bear out. But he’s especially concerned about the very young and the very old, whose microbiomes are most labile. They also happen to be the groups whose daily lives were most affected by the pandemic. “Kids haven’t been in day care or preschool,” Finlay said. “Elderly people have been isolated from their grandkids, who usually slobber all over them.” He is far from alone in this line of worry. “As a parent—not just as a researcher—I was extremely concerned by a lot of the plans for intense sanitizing in schools,” Melissa Melby, a medical anthropologist at the University of Delaware, told me. “The number of people reporting they were sanitizing everything they brought into their houses was pretty tremendous, and I think we have good reason to believe that dramatic changes in hygiene and sanitizing behaviors will affect our microbes, particularly for young children.” One result of this has already been observed: We’ve broken chains of transmission for all sorts of disease-causing pathogens, including common-cold viruses and influenza. Cases of these illnesses last winter were at recent-historic lows. And now that I think of it, it’s been more than a year since I’ve had a cold. I used to get them all the time, even though I’m pretty careful. Microbiome experts are not suggesting that it’s good to get lots of common colds; they say we should be grateful for the recent dip in these infections, just as we’re grateful that we haven’t lately stepped on a rusty nail. The “what doesn’t kill you” adage does not apply to respiratory infections any more than it does to tetanus. The more interesting question is whether I might have missed out on contact with other, more useful microbes along the way. I can’t remember the last time I shook someone’s hand. Whenever it was, it might have been the last time ever. A recent piece in The New York Times described researchers’ “mounting sense of dread” about these behavioral changes and their potentially “irreversible consequences.” But some are feeling optimistic. Certain effects could be positive, says Martin Blaser, the director of the Center for Advanced Biotechnology and Medicine at Rutgers University. For one thing, because people didn’t get colds, they also didn’t get (inappropriately) prescribed antibiotics. Many of these are crucial, even lifesaving, therapies. Used too often, though, they can disrupt microbial diversity in the body. If the pandemic helped mitigate their overuse and misuse, that’s “unquestionably good” from Blaser’s point of view. As for those of us whose microbiome might be lacking because of isolation, Blaser has more hope. “The microbiome in older kids and adults is very resilient,” he says. The microbes that we acquire from other people later in life don’t seem to stick around so long, or to fundamentally alter the microbial foundation that each person develops very early in life. Married couples, for instance, share far less of their biomes than do a mother and child. Whether the loss of social contact over the past year matters for our microbes in the long term depends on how we transition out of this period. For older kids and most adults, Finlay reassured me, “the damage is not irreversible.” That is, your microbial diversity may fall, but your foundation stays with you. High-fiber diets can help bring the diversity up again. “Instead of a sugar and white-flour diet, try to eat more nuts and seeds and legumes,” Finlay recommended. Spend time outside when you can, and hang out with animals. “Dogs are a great way to get microbial exposure.” For me, this was all very reassuring. I got a dog during the pandemic, and I’ve spent a lot of time outdoors because there’s been nothing else to do. I’ve also eaten better because I’m cooking more and not grabbing a pizza slice every few hours (this is what New Yorkers do). You know, this pandemic may have been okay for my microbes. Maybe even good? [Read: How your social life changes your microbiome] It’s not just me. In many families, young children were able to spend more time with their parents and pets than they otherwise would have. “I actually got my family outdoors more,” Melby, the medical anthropologist, told me. But these benefits have not been uniform across the population. Although “some people have improved their lives in terms of microbial exposure,” she said, “I know a lot of people who went the other direction.” Among the latter are those who have lacked access to safe parks and neighborhoods, high-quality food, and clean air. “I think the way this is going to play out is going to be very dependent on what resources people had during the pandemic.” “If they have the income to do it, there are measures people can take to make sure their young children develop a healthy microbiome,” says Tamara Giles-Vernick, who studies medical ethnohistory at Institut Pasteur. In particular, she says, breastfeeding at an early age seems to play a role in setting the foundation of a child’s microbiome. This may have been easier during the pandemic than during normal times, for people who have worked from home. For those who have had to take on second jobs, the inverse is true. A microbiome gap is evident even in nonpandemic times. “Generally, communities of lower socioeconomic status tend to have less diverse microbiomes,” says Katherine Amato, a biological anthropologist at Northwestern University. In its most extreme form, this paucity is known as “dysbiosis” and is strongly associated with metabolic and autoimmune disorders. But the research is just beginning to scratch the surface in terms of microbial disparities, Amato says. “Things like stress, diet, shift work, and disturbances in circadian rhythms can have negative impacts on the microbiome.” Baseline inequities that affect the microbiome are clearly playing into the disparities in who’s dying of COVID-19. Whether the microbiome itself is a factor in those outcomes remains to be seen. “Many high-income countries have moved to vaccinate the elderly first, and that’s incredibly important in terms of reestablishing normal microbial inputs,” Giles-Vernick says. Opening up nursing homes to outside visitors as soon as possible, too, may have more than purely social and psychological benefits. The same goes for common areas in nature. “In France, we’re in confinement, but unlike last spring, we can go to parks,” Giles-Vernick says. “That’s a really important measure.” The ongoing challenge is to avoid binary thinking about microbes: They are not simply good or bad, any more than people are, and neither is Purell. “Everything can be overdone,” Blaser reminds me, and that includes sterilizing things. We should instead make targeted hygiene the goal—and focus on the proven, effective methods to prevent disease transmission. Hand sanitizer can be a miracle during a cholera outbreak; that doesn’t mean you should shower in it after every Zoom call. (If you do this, contact one of these researchers.) from https://ift.tt/3gQYWNX Check out http://natthash.tumblr.com
0 Comments
While wealthier countries reopen, India and the rest of the world face a terrifying new peak in the pandemic. How did it come to this? What can be done? And with new variants and limited supplies, how does the global vaccine strategy need to change to prevent more coronavirus spikes? Staff writer Yasmeen Serhan joins James Hamblin and Maeve Higgins on the podcast Social Distance to explain. Listen to their conversation here: Subscribe to Social Distance to receive new episodes as soon as they’re published. What follows is a transcript of their conversation, edited for length and clarity: Maeve Higgins: Could you explain the situation in India for listeners? Yasmeen Serhan: If you were paying attention to India about a month ago, you probably wouldn’t have thought that we’d be here now. Cases weren’t that high, particularly for a country of 1.3 billion people, and the government was really talking about the pandemic like it was a challenge of the past. The health minister said that India was in the “endgame” of this pandemic. Meanwhile, you saw large political rallies, religious festivals, even some cricket matches. It felt like people were lowering their guard and life was resuming normalcy. Fast-forward several weeks later, [and we’ve] started to see these incredible increases both in cases and in deaths. Not only is India recording more than 350,000 cases a day, it’s surpassed more than 300,000 new cases for the sixth day in a row. If you look at the charts, it’s not a wave or a curve. It’s like a wall. And then, of course, all those numbers hit home when you see the actual images of people waiting outside of hospitals not being able to get in, not having enough oxygen. Doctors who are just struggling, saying they’ve never dealt with anything like this—even during the first wave. It’s a really, really depressing situation. James Hamblin: Yeah, there’s something that doesn’t come through in the numbers that does when you hear stories that there aren’t enough graveyards, or there’s not enough wood to burn funeral pyres. People are dying because of something as simple as not enough oxygen in a hospital, if you’re even lucky enough to get a hospital bed. Given what we know about how to prevent this disease, we have some level of vaccination and population immunity—and [it] clearly is far from over—but I didn’t think we would get to a point of that level of severity at this point in the pandemic. How did this happen? Is India really far behind on vaccination? Is there not as much population immunity as they might have thought? Serhan: There were a number of factors. The first is with vaccination. Despite the fact that India is home to the world’s largest vaccine maker, the Serum Institute, and despite the fact that it’s engaged in a lot of vaccine diplomacy—giving doses to a number of its neighbors—India actually hasn’t vaccinated a large portion of its population. The fully vaccinated population stands at about 1.7 percent. And with all its domestic manufacturing [now] just targeted on India, that isn’t proving enough right now. So vaccination was part of it, [as well as] what I talked about before—but also the variants. Virtually every variant of concern that we know about [is] in India right now. And we’ve seen the emergence of a new Indian variant, which is also currently being studied; some experts that I’ve spoken to fear that it’s behind a lot of the surge that we’re seeing right now. So it’s a confluence of factors, none of them very good at all. Hamblin: Something really important to keep an eye on in the coming weeks [is] what we can understand about how many people are being infected. Is this simply a case of an immunologically naive population? Or did immunity wane, and people are being re-infected? Or are the variants hitting people in new ways that we need to understand better? In any case, it’s clearly, acutely, a crisis for the country—which, as I understand, had been exporting a lot of vaccines but now has to stop that and focus more domestically. Does that mean adjacent countries who were counting on vaccines from India are going to feel ripple effects of this? Serhan: Yes. And unfortunately, it’s going to be some of the countries that need vaccines the most [and] that currently aren’t getting them. The Serum Institute is one of the biggest providers to COVAX, the international initiative aimed at equalizing vaccine distribution around the world. There are 92 low- and middle-income countries that have been relying on the Serum Institute to begin vaccinations. And the Serum Institute had to go to COVAX and effectively say: “Look, we can’t ignore the crisis at home. We need to turn our attention to India. We’re not going to be able to supply as many doses as we said we would, at least for the next couple of months.” It’s kind of a domino effect: One country’s crisis is every country’s crisis. Because what happens in India doesn’t stay there—not just with variants, but also with vaccines. If India can’t act as the pharmacy of the world, then other countries suffer too. Hamblin: Is there a country in the world that has a ton of vaccines and could help out? Higgins: Yeah, how many extra doses does the United States have? Serhan: Duke University’s Institute of Global Health has done a lot of work tracking vaccine procurement and manufacturing. And what they found is that the U.S. has secured more doses than it will ever need. [According to] its most recent report, even if you take out the doses that the U.S. will likely need for booster shots and to vaccinate children when they become eligible, the U.S. could have as many as three hundred million surplus doses by the end of July. Higgins: And that’s what you call vaccine nationalism—when one country is, at the expense of other countries, just looking out for themselves. Serhan: Exactly. The way that I think about vaccine nationalism is like the instructions on a plane for when the cabin pressure drops and oxygen masks fall in front of you: “Put your mask on before helping others.” The way that predominantly wealthy countries have kind of done this, they’ve basically said: “We’re going to put on our own mask; we’re going to take care of ourselves first and vaccinate our population. But we’re also going to take some of these other oxygen masks on the plane, just in case. We may not need to use them, but we’re just going to keep them.” And there are a finite number of masks, just as there are a finite number of vaccines. Higgins: That is a really horrifying metaphor. Serhan: It’s the way I’ve figured out to drive home the fact. Because to hear that wealthy countries “hedged their bets and bought a lot of doses because they have that purchasing power” doesn’t quite drill home the impact that has on countries who didn’t have that purchasing power and who couldn’t purchase those doses. Higgins: Are there examples of other countries stepping in and offering to help? Serhan: Well, India was one of those countries doing a lot of “vaccine diplomacy,” as it’s come to be known. Russia and China have also been quite aggressively sending their doses around the world for free, or at a very cheap price. Other countries, predominantly those in Europe or the United States, have largely stayed out of this game. And the main reason given is that they have doses, but they don’t have enough of them. In the meantime, other countries like China and Russia are stepping in and filling that void. Hamblin: What about export controls on the materials that go into making vaccines? Could more be done to support India’s manufacturing? Serhan: Definitely. Both India and South Africa appealed to the World Trade Organization to temporarily waive rules around intellectual-property protections for patents and regulatory data, which would basically allow other countries to produce COVID-19 vaccines and therapies without fear of being sued. This is an appeal that’s been supported by around a hundred mostly developing countries, several former leaders, and even some U.S. lawmakers. Hamblin: It seems to me we’re sort of behind the ball. Some of these vaccines you can’t immediately ramp up production of—certainly not very easily—but people think that if we open the intellectual rights right now, a country like India might be able to make more than they currently are. Serhan: Yeah; that’s the hope. Critics will probably say that it’s not a silver bullet. Some of the lawmakers in the U.S. that I’ve spoken to about this see it as a way to effectively lift the burden on other countries and say: “We need to give countries that need vaccines the means to make it themselves. We shouldn’t just be hogging this intellectual data.” And it’s a temporary waiver. The idea is that desperate times call for desperate measures. As for whether it will happen—at the moment, the U.S., the E.U., the U.K., and a host of other countries are opposed to it. So it remains to be seen whether there will be enough pressure to change that. We’ve already seen so much movement in the last few days. Before just a few days ago, the U.S. wasn’t sharing raw materials. A few days ago, the U.S. wouldn’t countenance sharing its doses, at least not any time soon. Now we’re seeing the U.S. do both of those things. So maybe the U.S. will reconsider its position on this, but it remains to be seen. Higgins: Can I ask about the variants? Something you have both written about and we’ve talked about on the show before is: Until it’s gone for everybody, it’s not gone. Jim, can you explain this “double mutant” variant? Is it more transmissible? Hamblin: We don’t know yet. And I don’t like the term "double mutant." It is being advanced by officials and by media, but all these strains are constantly mutating. When a mutation becomes significant, it gets a name. Like, the worst one is E484K, which is the one in South Africa and Brazil that seems to help evade immunological protection, at least partly. The strain in India, B1617, has many mutations but two of note. Two ominous ones. But we don’t know more. And that’s one of the things you suggest in your story, Yasmeen—that maybe other countries could help do more genomic sequencing of the strains circulating in India to help better understand to what degree this variant is actually spreading, because that’s in everyone’s interest to understand globally. Serhan: Yeah; as I understand it, India’s sequencing very, very few cases right now. Which is a problem, because you don’t really know what’s happening on the ground beyond the fact that hospitals are overwhelmed and that death counts are rising. But until you can ramp [sequencing] up further, it’s hard to really know what risk this variant poses and whether it can evade vaccine immunity or anything like that. We don’t know anything about it yet, so there’s no suggestion to say that it’s that serious. They’ve not even labeled it as a “variant of concern” yet, just a “variant of interest.” But I think the broader lesson is that the world really needs to start treating these variants like they could be variants of concern—like they could, God forbid, evade vaccines or be more transmissible and more deadly. I think we’re soon going to find that real political leadership is going to mean looking to the rest of the world and figuring out: How do I protect my population and everyone else from looming threats? Just because you vaccinate your population doesn’t mean that they’re automatically safe if this pandemic is ravaging the rest of the world. from https://ift.tt/3e5Cgrw Check out http://natthash.tumblr.com On my kitchen wall hangs a very small and very adorable cat calendar, with May 23 circled in Sharpie. It’s the day my Pfizer vaccine will, at long last, blossom into “full vaccination,” as sanctioned by the CDC. I’ll be able to safely venture outdoors unmasked and skip post-exposure quarantines. I’ll be able to schmooze with other immunized people indoors—perhaps even travel across state lines to visit family members I haven’t hugged since last spring. In a matter of weeks, social life as I know it will crack open. And a pretty big part of me is flat-out terrified of what lies within that widening maw. The world is a long way from vaccinating most of the human population. But here in the United States, nearly a third of Americans have gotten the COVID-19 shots they need for full immunity; we have three safe and effective vaccines, and in the coming months, more will join them. With inoculation comes a ballooning list of perks. But after a year underground, many people, myself very much included, are hesitant to shed their solitude and reestablish the norms we so staunchly swore off. As enthused as I am about immunity and vaccines, I’ve found some degree of comfort in my COVID cave. I have spent months confirming that what occurs within its boundaries is very, very low-risk, and I’m not terribly desperate to crawl back into the sunlight. Part of the reason is that I am, as my colleague Joe Pinkser calls it, Team Couch, and naturally gravitate toward a social life that stays in the slow lane. But I also dread the behavioral baggage packed into that tiny needle prick—a whole new set of calculations to make about risk, without a comprehensive playbook to guide me. As researchers learn more about the coronavirus and the vaccines, the rules of immune existence are changing at breakneck speed, and my emotional valence just can’t keep pace. I will soon be sludged down in a pit of post-vaccination inertia, and I expect to be mired there for weeks. “You can’t just turn off that anxiety; it’s got to power down,” Kenneth Carter, a psychologist at Emory University, told me. The newly vaccinated have been tasked with reclassifying a whole suite of behaviors that were very recently dangerous, breaking months-long habits that were set and solidified during a time of crisis. “Recalibrating around that is tough,” Carter said. Take, for instance, this week’s headliner switcheroo. Per the CDC, vaccinated people can now, under most circumstances, eschew masks outdoors—a massive flip from a year of calls for near-ubiquitous shielding. Some people have already easily, almost intuitively, made the hop; others have been there for months. But plenty are having trouble toggling their brain from masking modesty to face-exhibiting exuberance. Carter, like me, is taking things slow. He passed his full-vaccination milestone a few weeks ago. He’s not ready to host friends from out of state, but he has dined outdoors at a restaurant and visited his immunized neighbors—CDC-approved, low-risk activities that were fixtures of his life in the Before Times. Yet adding those behaviors back to his repertoire still felt patently weird. Carter’s brain has intellectually squared his change in circumstance, he said, “but knowing something is safe and feeling safe are very different things”—a sentiment my colleague Amanda Mull captured in the fall. [Read: The difference between feeling safe and being safe] “We’ve conditioned ourselves to behave in a certain way for the past year,” Jennifer Taber, a health psychologist and risk expert at Kent State University, told me. Much of that training involved shattering and reassembling our intuitions about safety; our pandemic behaviors have become deeply ingrained, going past the point of routine and into the realm of dogma. “I’ve had nightmares or dreams where I’m in a crowded place and I realize I’m not wearing a mask and no one else is wearing a mask. For me, it’s been associated with a lot of anxiety,” Taber said. Unlearning those emotional associations requires making some sharp U-turns; each person’s mileage will vary, and plenty of us should expect to feel some whiplash. Taber is also fully vaccinated, but she keeps having to remind herself what that means. While planning a visit with friends this week, she found herself worrying about the weather—only to realize that everyone invited was at least two weeks past their final dose, allowing them to mingle indoors. “It hadn’t even occurred to me that we could do this inside,” she said. Pinballing back to regular hobnobbing might be easier for people whose jobs and responsibilities have kept them in close proximity to others. My partner, a health-care worker, is among them. He never swore off people the same way I did; he was unable to. (My work situation has put me in a great position of privilege.) If anything, he’s interacted with more people than usual this past year, and since his shots, which took hold more than two months ago, he has slipped almost seamlessly back into regular hangouts with his vaccinated friends and co-workers. They want me to join them as soon as I feel ready. I don’t know when that will be. [Read: Two competing impulses will drive post-pandemic social life] Experts told me that some of my molasses-y feelings can be traced back to just how much ambiguity we’re all being asked to deal with right now. Vaccinations are up, but so are infection rates in many parts of the country. The virus is still evolving and, on occasion, sprouting new versions of itself that could continue to trouble us. And the post-vaccination guidebook changes on a near-weekly basis, as researchers hustle to learn more about SARS-CoV-2 and the tools we’ve built to fight it. Keeping up with the shifting guidelines can result in, as Taber put it, information overload: tiring at best, and maddeningly confusing at worst. The CDC’s most recent mask recommendation, for instance, is grounded in good evidence, but also sets pandemic norms askew. Maskless people strolling down the street could now be immunized rule followers or uninoculated defiers. Rather than trying to keep up, some vaccinated people might decide to maintain their pre-shot baseline until most everyone else is in the clear. “In some ways, it’s easier to just default to ‘Nope, I’m just staying home,’” Kimberly Powers, an epidemiologist at the UNC Gillings School of Global Public Health, told me. The risk calculus is especially tricky for people in mixed-vaccination households. Most kids can’t yet get their shots; certain people, such as those taking immunosuppressive drugs, might not benefit as strongly from the vaccines. Vaccination is an individual event, but its repercussions affect everyone around us. Tara Smith, an epidemiologist at Kent State, told me that she and her partner will be fully vaccinated next week. But her 7-year-old son won’t be eligible for shots anytime soon, so the whole family is calibrating their behavior to accommodate his still-elevated level of risk. “I’ve spent the past year being cautious,” Smith said. “I don’t want to blow all of that up.” [Read: We’re turning COVID-19 into a young person’s disease] Just months ago, most members of the population stood on roughly equal public-health footing: The same general guidelines applied to just about everyone. Now the rules are splintering. That punts a lot of the work to us, as individuals, to tailor the rules to our particular lives through ad hoc risk-benefit analyses. Allison Chamberlain, a public-health expert at Emory, points out just how much flexibility this requires. The CDC has laid out clear tips on masking and assessing the relative safety of various venues, decisions that each individual has at least some control over. But local circumstances, including ongoing outbreaks and community vaccination rates, are also crucial to consider. Vaccines offer a layer of protection, but aren’t impermeable; the more virus that’s around, the more infection and illness will occur. The experts I spoke with recommended following reports from local health departments, a bit like checking the weather before deciding how to dress for a day outdoors. “It won’t always be the same suite of mitigation measures for every circumstance,” Chamberlain told me. The goal is to weigh the risk you’re considering against the risk you’re willing to take on—essentially figuring out if the potential boost to your well-being is worth it. That threshold will vary from person to person, and we should make room for that diversity, Taber said. Some people will want to dip their toes into the water more slowly, as Carter put it, and that’s okay. Inevitably, people’s social expectations will misalign, and we’ll all need to exercise some patience, with ourselves and others, and clearly communicate our ground rules. “Say what you need and what you feel comfortable with,” Carter said. The activities we can safely do after vaccination should not necessarily be seen as the behaviors we should engage in; they are options, not obligations. That sort of transparency isn’t intuitive for everyone, certainly not me. I have spent months roiling in a data-rich stew of fear and silence. I’m also worried about my own limitations. There is, first off, my lingering COVID-19 concern: I can’t help but worry that, even after I’m fully vaccinated, I’ll make a misstep—that I’ll somehow catch the virus and pass it on to someone else. I’m also worried that, amid all this chaos and isolation, I’ve simply forgotten how to be a social human. Charisma isn’t like riding a bike. And I’m not eager to show off just how far I’ve regressed—how much the pandemic has eroded my ability to engage. The way to quash that fear is, of course, to flex the mingling muscles that have atrophied, and to remind myself that, as misanthropic as I can be, I do enjoy exercising them from time to time. Instead of yielding to my inertia, I’m reminding myself of the things I miss: hugging my friends. Smelling fresh-baked restaurant bread. Heading to an office that isn’t 30 feet away from my bed. I’m going to start slow, probably with a haircut or an outdoor picnic, then work my way up to the 18,000 weddings I’ve been invited to this fall. I’ll share my vaccination status with the people I want to interact with, and hope they offer me the same courtesy in return. I’ll learn how to say “Thank you, but I’m not ready for that” without the guilt eating me up. Reacquiring what little social acumen I had before might take some time. But I’m looking forward to the day when I’ll be able to walk down the street without a mask and exchange an awkward smile with a stranger, knowing that the world is safer—that we have the option to interact, even if we’d both rather not. from https://ift.tt/32Za96X Check out http://natthash.tumblr.com Yesterday, the CDC released more relaxed mask guidelines for outdoor activities, as well as new charts for indoor and outdoor recommendations. The more permissive guidelines were a welcome step forward, but they’re still frustrating. By issuing recommendations that are simultaneously too timid and too complicated, the CDC is repeating a mistake that’s hounded America’s pandemic response. The new guidelines are rigid and binary, and aren’t accompanied by explanations or a link to an accessible version of the underlying science, which would empower people to both understand them better and figure things out for themselves. The new guidelines come with charts that list specific activities and how a person should engage in them, based on their vaccination status. The charts illustrate people wearing masks or not, with different colors and mask statuses for vaccinated and unvaccinated people, depending on the activity. The chart for outdoor activities suggests that masks are not necessary for walks or runs, for example, if people are by themselves or with their household, regardless of vaccination status. However, unvaccinated people are advised to wear a mask at “small” outdoor gatherings that include other unvaccinated people, but the people are still marked “safest.” Colors change, too: Yellow is used for the unvaccinated dining outdoors with multiple households, marked as “less safe,” though the earlier “small, outdoor gathering” does not clarify household status. Crowds have everyone masked, but the colors are different: red for the unvaccinated, green for the vaccinated, who are wearing masks but marked “safest.” Confused? You’re not alone. The guidelines got Linsey Marr, a professor at Virginia Tech and a leading expert on viral transmission, to remark that even she can’t remember all of this. “I would have to carry around a sheet of paper—a cheat sheet with all these different stipulations,” she said in an interview after the announcement. And despite all the detail, social media was flooded with questions from people who couldn’t figure out what they should do in different settings. What happens if they live with someone who is not vaccinated or has medical issues? What counts as a crowd? How small is a “small, outdoor gathering”? Why are unvaccinated people “safest” at a small outdoor gathering but not at an outdoor restaurant? And why is a crowd a threat to the vaccinated? What does the color coding for unvaccinated people indoors mean exactly, since they are advised to wear masks at all times? The CDC should, at the very least, explain the scientific reasoning behind these rules. Not only would this empower people; it would inform the inevitable debate about the guidelines. [Read: Are outdoor mask mandates still necessary?] We wear masks for three reasons: to protect ourselves from people who might be infected, to protect others from our infections, and to set social standards and norms appropriate for a pandemic. The last one is the most important: A pandemic requires a collective response. As we learn more, we move from broader precautions to targeted mitigations. Early in the pandemic, the existing guidelines that suggested only the sick should wear masks and the objection that we didn’t know all we needed about the effectiveness of masks violated both the need for social norms, by stigmatizing the sick, and the precautionary principle, by letting remaining uncertainty stop us from protecting ourselves as best we could even with imperfect knowledge. So we changed the rules. Now, a year later, both the sociology of outdoor masks and the precautionary principle operate in the opposite direction, because the science is in. We need to change the rules again, but also explain why. Let’s start with the outdoors. Study after study finds extremely low rates of outdoor transmission. So far, I’m unaware of a single confirmed outdoor-only super-spreading event, even though at least thousands of confirmed super-spreading events took place indoors. (The Rose Garden party to celebrate Donald Trump’s nomination of Amy Coney Barrett to the Supreme Court and the multiday Sturgis motorcycle rally in South Dakota both had extensive indoor components.) When outdoor transmission does occur in small numbers, it’s not from fleeting encounters, but from prolonged contact at close distance, especially if it involves talking, yelling, or singing. An increasing number of scientists believe that outdoor and indoor transmission differs so starkly because the coronavirus transmits through aerosols—essentially little floating particles that we emit, even if we are just breathing, but even more if we are talking, yelling, or singing. Unlike droplets, these aerosol particles do not immediately fall to the ground with the force of gravity within three to six feet, and they concentrate most around the person emitting them, so close contact remains risky. Crucially, they can disperse quickly if they are released in the great outdoors, or, conversely, they can keep accumulating in a poorly ventilated, enclosed environment and travel beyond the short distance in which droplets would fall. The risk of transmission depends on the person, place, and activity, and the first is the hardest to be sure about. The rate of aerosol emission varies greatly among people, and the viral load in infected people changes throughout the disease’s progression, peaking right around symptomatic disease for most. Plus, we don’t always know who is vaccinated. But we know where we are and what we are doing—whether we are outdoors and whether we are interacting at close length. So even without taking vaccines into consideration, the previous guidelines that recommended masks in “public settings,” including outdoors, were already too rigid and too timid. Now that nearly 100 million Americans have been fully vaccinated, we have to factor that into our risk assessment. The CDC has been loosening rules for the vaccinated, and there, too, the guidelines have an implicit message. For example, the CDC does not require vaccinated people to quarantine after exposure or travel unless they get sick. The totality of the evidence so far indicates that vaccinated people are not just incredibly safe from severe disease or death, but they are very well protected against symptomatic COVID-19. These no-quarantine-required rules show that the CDC further believes that the risk of unknowing transmission due to an asymptomatic infection can be considered so minuscule as to be negligible. So perhaps although one can imagine that vaccinated people may transmit COVID-19 indoors in very, very rare cases, it’s harder to imagine the chances of such transmission occurring outdoors to be anything but vanishingly low. [Read: Why aren’t we wearing better masks?] To add to the confusion, in earlier guidelines, the CDC already said that vaccinated people could meet indoors without masks even if one of the households had unvaccinated members. It’s confusing to say that vaccinated people can meet indoors without masks with unvaccinated people in one guideline, but that they should wear masks outdoors in a crowd in another guideline, without further explanation of why. If the idea is that, in crowds, we should keep masks for everyone because of sociological reasons, to avoid the awkwardness of selective mask enforcement, the CDC should just say so. What about rules for vaccinated people indoors, then? One could argue that the science is already fairly strong that the vaccinated are likely fine even indoors, especially if community transmission isn’t very high, and that the CDC guidelines implicitly assume this. That said, one can concede that this part of the empirical record is still evolving. However, that’s not currently relevant for public rules and behavior, because just like we can’t tell only the sick to wear masks, we cannot tell only the vaccinated to chuck their masks indoors—a grocery-store clerk shouldn’t have to police this. For now, indoor spaces have to keep masks as a rule simply for sociological reasons. We should make that explicit too. The CDC needs clearer, science-based guidelines that inform and empower us. People do not need a complicated patchwork of charts with rigid, binary rules. The science supports a simple guideline that allows for the removal of all mask mandates outdoors, except for unvaccinated people in prolonged close contact, especially that involving talking, yelling, or singing. (As Marr notes: Either masking or social distancing can be sufficient outdoors.) If you are vaccinated but want to increase your comfort because transitions can feel abrupt, or if you are concerned, for example, because of an unvaccinated or vulnerable household member, you can keep your distance and wear a mask, but a mandate for everyone else is not required. Having the CDC spell this out with nuance is better than strict rules that can create stigma and therefore put unwelcome pressure on people with specific circumstances, such as the immunocompromised. Plus, it’s good to adopt the social norm that, outdoors, we should let people be masked or unmasked, especially because shaming and scolding in either direction is unwarranted. Finally, the CDC guidelines are not just timid and inconsistent. They are late: We’ve known about outdoor transmission being a much lower risk for almost a year now. We should move cautiously, for sure, but excessive caution creates fatigue and mistrust. In the United States, case counts and deaths are trending down thanks to our impressive vaccine supply, and because of the tragic reality that millions have already attained some level of immunity from being infected. Over the past year, we’ve also gained tremendous understanding about transmission risks—where they are high and where they are very low. It’s time that our rules reflect that reality, and spell out their reasoning explicitly, so they can inform and empower us as we trudge through the rest of this miserable pandemic. from https://ift.tt/3e4NRr3 Check out http://natthash.tumblr.com In the summer of 2009, when Diana was three and a half years old, her health took a tumble. She began to run high fevers and vomit, and gain weight at a baffling pace. She made several trips to the emergency room over the course of two months before doctors finally diagnosed her with two rare, life-threatening conditions. The first, atypical hemolytic uremic syndrome, went after her kidneys, “and really messed them up,” Diana told me. The other, secondary hemophagocytic lymphohistiocytosis, sparked waves of inflammation, and walloped just about everything else. Diana spent months receiving chemotherapy, immunosuppression, and dialysis treatments, and about five years on a low-sodium, low-potassium diet. Sometime during the acute phase of Diana’s illness, Jo noticed that her daughter was holding her books too close to her face. Her optic nerve had been damaged, leaving her legally blind. Diana is now 15, and her two conditions are in remission. (The Atlantic agreed to use only her and her mother’s first names to keep her health status private.) When the pandemic began, she was a straight-A student closing out her freshman year at a competitive magnet school in Manhattan. She was learning bass guitar to start a band with her friends. She used a white cane, took a fistful of medications morning and night, and was still cycling through the offices of about half a dozen doctors each year. But her medical visits and treatments had, for years, felt routine—background noise to her vibrant life. Then the coronavirus crash-landed in New York, relegating Diana and her parents to their three-bedroom home in the Bronx. Last March, her classes went entirely virtual, lashing her to a computer for most of her day. By the beginning of April, Diana was dealing with a trio of new symptoms. Within minutes of turning on a screen, she’d be flooded with a wave of nausea—rocking, jolting sensations that made her feel like she was trapped in a zigzagging car. Pain would intermittently grip the sides of her head. And for about 80 percent of her day, she told me, her eyes ached as though “someone had been holding them open for a really long time,” making it nearly impossible to find and focus on the words and numbers that flashed in front of her. She’s had little respite in the year since, as her doctors have struggled to diagnose her symptoms and rein them in. It’s a bad spot to be in, Diana told me, while her classes are still taught mostly on Zoom, and her social relationships are tethered by virtual lifelines. Early last fall, she decided to permanently log out of the Discord platform that her friends have been using to exchange messages, despite knowing how severely it would deepen her isolation. “I’ve missed half a year of inside jokes,” she told me. “It’s hell.” The triad of neurological symptoms has been so consuming that the threat of the coronavirus itself blipped almost entirely off Diana’s radar. Despite following all precautions, she got a mild case of COVID-19 a couple of months ago—likely during a trip to the optometrist, and within days of both her parents’ second shots. She took the virus seriously, holing up in her room and leaving only to make masked trips to the bathroom. A year into battling her mystery illness, getting COVID-19 was “almost a relief,” she said. This time, at least, “I knew exactly what was wrong with me.” Diana is, in some ways, an exceptional case. At 15, she is on the cusp of being eligible for Pfizer’s vaccine, but can’t yet receive the lifesaving shot. She is African American and Asian American—two groups that have experienced heightened discrimination in recent months—though she and her mom say race hasn’t been a huge factor in their pandemic experience. Her chronic health issues are an additional stressor; in the pandemic’s early months, Jo worried that her daughter’s weakened kidneys would put her in the coronavirus’s crosshairs. In a time of chaos, Diana has had to seek more medical care, not less, upping her exposure to others. The changes the global crisis has wrought seem to have broken the tenuous truce she had with her health. “The quarantine, the isolation, the remote learning, that has been tragic—that has hit everybody,” Carolina Pombar, Diana’s pediatrician at Mount Sinai, told me. “In her case, I think it has been even worse.” But within Diana’s pandemic experience are echoes of many others’. Diana is one of millions of Americans living with a chronic health condition—many of whom have had to chart their own course through the pandemic. She is also among the many young adults who have been driven into hiding at a time when social development matters most, and have felt their optimism and self-worth diminish as a result. Around the world, teenagers are reporting serious declines in mental health—an alarming trend experts have called a “crisis” that will likely ripple throughout the rest of adolescence and beyond. Much of COVID-19’s health fallout, they told me, will have nothing to do with the coronavirus itself, but everything to do with the pandemic it has caused. The stress, solitude, and interminable parade of screens have certainly eroded Diana’s mental and physical well-being. Since last spring, when the headaches, nausea, and eye pain started, she’s roughly quadrupled her trips to doctors, in specialties as wide-ranging as neurology, ophthalmology, allergy, gastroenterology, and otolaryngology. Even after a year of tests and dozens of appointments, Diana’s doctors aren’t completely sure what’s at the root of her symptoms. The latest theory revolves around a potentially deviated septum, which not only would provide the relief of a clear diagnosis but could be fixed with a same-day surgery. But that could still turn out to be a dead end. “I excel at stumping the medical community,” Diana told me. Remote learning—a hurdle that’s placed millions of children in front of screens this past year, and heightened their sense of solitude—likely bears at least some of the blame, a sort of collateral damage from the coronavirus. “It’s the fallout of the fallout,” as Diana puts it. She jokes darkly that she’s only now starting to hear her teachers and classmates complain openly of serious Zoom fatigue. “It took a year for this to catch up with y’all,” she said. “And it took me a month.” If the symptoms don’t let up soon, Diana could be in for a few more rough months. Her school is back to hybrid learning, with students on campus two days a week. But most of Diana’s classroom time, whether in person or not, remains dependent on Zoom; she still spends more than six hours of her day staring at screens. Although prescription lenses have given her back a decent bit of her vision, scrolling dizzies her; moving text strains her eyes. When she scans over a page, not all the letters register right away. She often has to skim words and guess what they are based on the context. Science and math are even tougher: “I can’t look at the beginning of a number and guess what the rest is going to be,” she told me. “My nightmare is asking me to read, letter for letter, a paragraph of gibberish.” Diana has to put far more energy into her education to maintain her top-notch GPA this year, and she’s exhausted all the time. She hasn’t always felt that the staff at her school understand the toll remote learning has taken on her health. She recalled telling one teacher that the lecture slides in class were too small to parse—a complaint that was met with a shrug: Well, I can’t make them any bigger. Even before the pandemic, Diana’s parents had repeatedly entertained the idea of moving her to a school that might make more accommodations for her visual impairments. But Diana loves her friends. She feels appropriately challenged by her classes; she has designs on a career in patent law. Now, the headaches, nausea, and fatigue are chipping away at her mental health. And many social interactions—the psychological bandages that once held her education together—have atrophied and disappeared. “If we’re not mostly in person, without having to be on Zoom, by next year,” Diana told me, “I think I’m going to lose it.” Pombar, Diana’s pediatrician, told me that most of her patients have had an absolutely miserable year. Some kids have been skipping routine immunizations. Others have retreated into unhealthy habits, spending eight to 10 hours a day playing video games. Many, like Diana, have seen their mental health begin to crack and crumble; Pombar has had to send several patients to the emergency room as a last resort. A few of her patients gained 30 to 50 pounds in just a couple of months, and are now teetering on the edge of morbid obesity. “That’s something that will kill kids silently,” she said. “An obese child is a very sick child, but nobody’s talking about that.” The power of being a pediatrician, Pombar told me, is being able to intervene early—to prevent health problems before they appear. That all fell to the wayside while the country descended into crisis. “It felt like you were at war and you had to choose which battles to fight,” Pombar said. “We’re now paying the price of all the things we pushed.” The psychological losses are even harder to nail down. Allison Agwu, a pediatrician at Johns Hopkins, told me that it will take a long time for researchers to fully capture what America’s youth have lost to the pandemic. It’s been a year “devoid of normalcy,” she said, and adding up chaos during a crisis isn’t easy: “Which part is the virus? Which part is society?” Diana, like many others, can’t pin her problems to a single inflection point. The entirety of the pandemic, this extended interruption to normalcy, is catching up to her in bursts. An only child, Diana is close with her parents. Their home is spacious enough that it easily accommodated her brief isolation when she tested positive for the coronavirus at the end of February. She practiced her bass, binge-watched Criminal Minds, and took her meals on trays. But even now that her tussle with the coronavirus is over, Diana doesn’t feel terribly liberated. Her world remains shrunken: Her home has, for more than a year, been her classroom, her entertainment center, her all-purpose nexus for existence. There is nowhere to escape to. She misses taking trips to Chinatown, and singing Disney songs with her friends. She misses sitting on her school’s campus with her classmates, filching grapes and crackers from their lunches. Diana is young for her grade, so many of her friends have already signed up for their COVID-19 vaccines; she’s not yet old enough. “I am forever salty about this,” she told me. (The Pfizer-BioNTech vaccine, which is currently cleared for people age 16 and up, will likely soon be green-lit for kids as young as 12, almost certainly before Diana’s birthday in November.) I asked Diana how long the pandemic will stay with her. Years, she predicted. The 13 months that COVID-19 has consumed represent most of her high-school experience so far, and nearly a tenth of her life. She’s still processing the emotional toll, she told me—the misery, the exhaustion, and what the past year will mean for her future. “I’m very tired,” she said. “I don’t know. It has genuinely messed me up.” from https://ift.tt/32Q5KTQ Check out http://natthash.tumblr.com Once, we had a wide world of socializing opportunities: crowded bars and intimate dinner parties, stadiums full of strangers and weddings full of everyone we loved most. The coronavirus pandemic made many of those things dangerous or impossible, and shrank our social worlds dramatically. Now, as vaccination rates go up, the floodgates of social life are poised to reopen. But not everyone will want to use this newfound freedom in the same way. Even before the pandemic, introverts and extroverts disagreed on the optimal size and frequency of gatherings. Post-vaccine life may breed some misunderstandings between the extroverts who want to dive headfirst into a sea of other people and the introverts who are excited to see their friends but don’t want to pack their schedules so full that they have no time to just be. [Read: 2 competing impulses will drive post-pandemic social life] To get a sense of how these personality types are planning to approach life after the pandemic, I had a chat with two of my colleagues--Amanda Mull, an extrovert, and Katherine Wu, an introvert. We talked about what they are and aren’t looking forward to, how they would design the new normal if it were up to them, and how we can be kind to our friends who aren’t ’verted the same way we are. This conversation has been edited for length and clarity. Julie Beck: If we had an imaginary scale of introversion and extroversion with extreme introvert being negative 10, and extreme extrovert being positive 10, and zero being true neutral, where would you place yourselves along the scale? And why? Katie Wu: I don’t appreciate the connotation that I’m the negative one. I think I’m a negative six. Amanda Mull: I would say that I’m a positive seven. Wu: Amanda, I’m really curious why you consider yourself an extrovert and why you picked seven. Mull: The difference between being energized or drained by being around other people and being energized or drained by being by yourself seems like the most reasonable way to think about that. I just really like being around other people. I like being in a crowded bar. I like being on a subway train and just looking at everybody. I like people-watching. I like the energy of a situation in which there are a lot of people talking and being together. I find myself recharged by those situations. And it doesn’t mean that I dislike being by myself at home. There are definitely times for that. Before the pandemic, I would spend a couple of hours at home, and then I would just get bored and want to go walk around or sit at the coffee shop or see if a friend wanted to get a drink. It would just start to psychologically wear on me if I was alone for too long. It seems I pretty classically fit the idea of an extrovert in that way. I picked seven because I think I am a more ardent extrovert than the average person who fits that mold. Beck: Katie, why did you pick six? Wu: Amanda, when you were rattling off all those things that give you energy, I felt my heart rate go up, which was a big flag for me that I have identified my correct allegiance. I see myself as an introvert not because I’m a complete agoraphobe or don’t like people, but because I don’t derive any energy from being around other people. It drains me. I recuperate and gain energy from being alone. I appreciate the presence of other people. But I think what I desperately need in my life is the ability to control when I am around them. I don’t like being surprised by crowds. I like being able to set aside alone time and know that for these next three hours I don’t have to deal with anyone else. I think small talk is the tax that God exacted for the privilege of human speech. Beck: Damn. That was real. Wu: Yeah, I can’t do it. Honestly, I really need a haircut right now. And half of the reason I haven’t gone is because I want to wait until I’m fully vaccinated, but also because I’m really dreading getting asked a lot of questions by my hairdresser. Mull: I used to have a hairdresser who I really loved talking to, and sometimes on Friday afternoons if work was slow and nobody was in the salon, I would go get a blowout just because I wanted to chat with him for half an hour. Beck: Do you think that the pandemic has changed where you fall along that scale or made you reassess your number? Mull: I have realized that I’m even more of an extrovert than I originally thought. Before, there were times when I would get overscheduled and think, It would be nice to have some more time to spend at home. And then I got a lot of time to spend at home, around no one, and I realized that I was scheduled like that because that is genuinely what I like. Wu: I miss social interaction, but I’ve been very fine this year. I really miss hugging, like, five other people, but I have no desire to see all of them at once and no desire to go to a bar or a party. I could do this for a while. Beck: What did you most hate about pre-pandemic life, and what did you most love? Mull: I hate scheduling things. I like to be able to call my own shots. If I want to go do something for dinner, then I’m going to go do that. Having to keep appointments and dates straight is hard for me. That’s probably not related to me being an extrovert; that’s probably related to me having ADHD. So I like the simplicity of things now. The thing I liked best about pre-pandemic life was being able to go sit in a bar on a Saturday night, and it’s just full of people. You’re with your friends, and you’re gossiping, just catching up on the Sturm und Drang of everybody’s lives. I want to go sit in a bar when it’s cold outside and it’s warm inside, and the front window gets clouded up. And everybody’s having a good time, and there’s good music. I really, really miss the energy of that situation. Wu: So many things had become background noise to me. I never really enjoyed being in crowded places or waiting in lines. But they’re not things that really bugged me on a daily basis. I do feel like there was a decent bit of social shaming of people who didn’t want to rally and go out all the time. I would feel guilty about that. And that’s something I don’t miss a ton. Beck: What have you most hated about pandemic life? And what do you most love? Setting aside the virus and the possibilities of illness and death, which we all hate. Wu: Yeah, I definitely hate those things. I really do hate not being able to touch and see other people. I actually didn’t live with my partner during the pandemic until a few months ago, because we got married and then he moved away to do his medical residency. For the first six or so months of the pandemic, I was alone in my apartment with my cats. That was a huge bummer. And now I’m so grateful I have him, but I have only him pretty much. I miss my friends. I miss my family. Mull: Something I really appreciated about the last year is that I really like to cook, which is not a great extrovert activity. This time has given me the space and opportunity to explore that hobby a little bit more, and I don’t feel like I’m sacrificing experiences that I enjoy in order to do it. The thing I hated about the past year the most is how cut off I’ve felt, not just from my friends and family but from the community as a whole. I live in New York, where the community life is—you’re sort of cheek by jowl with everybody. I was a regular at lots of places around my apartment. I saw lots of people I knew just walking around, going about my day. I really, really miss the serendipitous bump of energy I was constantly getting off of that. I can’t wait to see the people I used to see whose names I don’t know. I want those people back. Beck: If you were the boss of everything, how would you design life as we emerge from the pandemic? Mull: I think we had built a lot of unnecessary structures and expectations before the pandemic. What would be nice for everybody is to have some more flexibility and self-determination—flexibility in how people interact with work, flexibility around how people choose to navigate their social lives. If somebody finds it draining to go to the office every day, or if somebody has a particularly long commute, we know how to navigate around those things to make life more humane for more people. So why don’t we just do that? That is the big thing for me: Why would we discard the flexibility we found in the past year? We should keep it. Wu: I agree with that. I surprised myself by realizing how much I actually did miss having an office to go to this past year. I would love to meet my co-workers in person; I haven’t done that yet. But it’s not just about that. I really liked having separation, for work-life balance. And it’s going to be tricky to navigate that post-pandemic because now we’re all in this blurred state. But I hope conversations about that continue. [Read: The pandemic is changing work friendships] Beck: What do you think the norms should be as we’re getting back into socializing—norms around how we make plans, or norms around how and whether we rekindle the relationships that got back-burnered during the pandemic? Mull: Something that has been valuable about the past year is that we have talked more explicitly about boundaries. My friends have been forgiving of one another when somebody has a concern that means they choose not to participate, or when someone is just not feeling up for something. We have all learned to be more generous with one another and more mindful of one another’s psychological needs. Why not be just as mindful of one another in the future? Wu: I think this is more specific to me than necessarily an introvert thing, but I don’t do super well with people who just want to play plans by ear. Like, “Let’s meet up later.” I can’t put “later” in my calendar. Communication is super key. I also think a lot about what crowded gatherings are going to look like after this. I genuinely wonder if people are going to have trouble shaking the fear of, Am I actually standing six feet away from this person? I’m curious to see how that plays out in all the public spaces I inhabit. Beck: You guys are both very considerate and thoughtful. But in a broader sense, do you think there might be any conflict between introverts and extroverts in how they want to approach post-pandemic life? Wu: I have a lot of friends who are now planning their post-pandemic hooplas—weddings that were postponed or canceled, super-belated birthday parties, graduation parties, all these things that we missed—and I want them to be able to celebrate those things. But I’m also slightly panicking about the 15 weddings I’m going to get invited to in the span of four months. It’s a lot of pressure. I love all these people. But I personally need space between events to recharge. I always think of—this is so nerdy. I played a lot of Pokémon when I was little. There were those very evolved Pokémon who would do a really big move and had to spend the next couple of turns recharging. They couldn’t make another move. That’s me. I can’t do it! Beck: You’re just super-evolved. Wu: It feels like people are going to try to make up for all the lost social time, and I don’t think I’m equipped for that emotionally. Mull: Definitely in my mind, I’m like, Can I go on vacation? Can I go see my parents? Maybe I should have a party. I can see that people in my position who are really excited to be able to do those things might feel like people who are reluctant to do them, for non-safety reasons, are maybe being a little bit rude. I could see those miscommunications happening. Beck: Let’s do a lightning round of: Are you looking forward to these things? Working in an office. Yes or no? Wu: Yes. Mull: Yes. A couple of days a week. I don’t want to go back every day. Beck: Eating at restaurants? Mull: Yes. Wu: Yes. Beck: Travel? Mull: Yes. Wu: I hate travel. And now everyone’s gonna hate me. Mull: I will say that it gives me a ton of anxiety to have to plan a trip. I like being there. But I really dislike the logistics aspect of it. So I can agree with you on that. Wu: If I love you, I will travel to see you, hands down. That is always worth it to me. But I find travel stressful a lot of the time. I think it’s largely because of the ambiguity and too much novelty. Beck: Public transit? Wu: No. I was a staunch biker before the pandemic. Mull: Yes. I took the subway yesterday for the first time in more than a year to go get a root canal. And I was genuinely so glad to be on the subway. Beck: Parties? Wu: Nope. Mull: Yes. Beck: What about visiting other people inside their homes, not necessarily in a party situation? Wu: Yeah. Mull: Yes. Beck: What about big gatherings, like concerts or sports games? Wu: No, no, no. Mull: Sports, yes. There’s too much standing at concerts. Wu: Concerts are the few big, moshy-type things that I have enjoyed going to in the past. But I can’t do more than a couple a year. Beck: Are you looking forward to the end of Zoom meetings, or the great decrease in Zoom meetings? Wu: This one I feel kind of conflicted about. This is terrible, because I’m a reporter, but phone calls and video calls do scare me. I always have to psych myself up for them. I would much rather see someone in person than over Zoom. But Zoom is also super convenient sometimes; I’ve liked having the flexibility. Mull: I have not used Zoom that much. I have probably two Zooms a week. I really like talking on the phone. I appreciate Zoom as the tool it is, but I am glad that we won’t have to rely on it as much. Beck: Are you looking forward to the end, or decline, of Zoom happy hours? Wu: Yeah, it is really hard to have a happy hour on Zoom. I’ve been to a lot of awkward ones. But I super-appreciate the effort. Is it better than no happy hour at all? Probably yes. Beck: But only just. Mull: I have not been to a purely social Zoom happy hour since May 2020, I think. As soon as my friends were able to go sit in a park or sit outside of a bar or something, we started doing that instead. I cannot imagine a scenario in which I will opt into a purely social Zoom happy hour ever again. Unless there’s another pandemic. I think that they are a poor excuse for the real thing. Wu: If I come to a happy hour, there’s a 99 percent chance I came primarily for the free food. Can’t do that over Zoom. Beck: You can’t. That’s true. Mull: Gotta provide your own snacks. Beck: Okay, great lightning round. Do you have closing thoughts on how we can bridge the introvert-extrovert divide as we emerge into the sun again? Wu: I have been slightly sad to see the stereotype that all introverts want quarantine to last forever. That seems oversimplified to me. I think we all want the pandemic to end and to see one another. I love my extroverted friends. Mull: I think that to bridge the gap, what has worked so well, at least among my friends, is just being really explicit and direct with our needs and our concerns. I could imagine a future in which, if I had an introverted friend and they needed to cancel something because they just needed to recharge—if they told me that, it would be totally fine. I hope that we can continue to be really explicit with each other about our needs and our boundaries. from https://ift.tt/3vkTBCA Check out http://natthash.tumblr.com Photo illustrations by Aikaterini Gegisian I am a 39-year-old woman, and I have never, to my knowledge, had an orgasm. I include the caveat because I’m often asked—by the men I’ve slept with, by my closest friends, even by my gynecologist—if I am sure. The question can feel vaguely patronizing, but it also fills me, and others like me (studies tend to put the share of nonorgasmic women at 5 to 10 percent), with a creeping sense of self-doubt. “Do you think we actually have and just don’t know it?” my friend Lizzie—not her real name—wondered aloud the other day. “Like maybe orgasms simply aren’t that great?” I thought for a moment. I love sex, and I’m probably on the kinky side—there’s very little that I haven’t tried. But no matter how much I am enjoying myself, there inevitably comes a time, both on my own and with a partner, when the physical pleasure, having built and built, either fades to nothing or becomes a sensation too uncomfortable to bear, and provides neither the rapture nor release I have imagined and sometimes even conjure in my dreams. “I don’t think that could be it,” I said to Lizzie. “I mean, we’re not idiots.” The nonorgasmic thing wasn’t really a problem when I was in my teens and early 20s. For years I relished the novelty of touching and being touched by someone separate from myself, not to mention the discovery—I must have been about 11—that I could slide my pelvis beneath the bathtub faucet and elicit that delicious-and-then-unbearable sensation I described above. Even in college and beyond, when physical intimacy became more commonplace, I remember being fairly phlegmatic about the whole thing. “These boys, they don’t know what they’re doing,” said the pediatrician I still saw as an adult when I asked her about it, and she was largely right, of course, not just of the boys who had never once thought to ask if I had also come, but also of those for whom my gratification became a kind of virility contest, and one at which I may as well have been a spectator. (I can only speak to the experience of being a straight, cisgender woman, but it’s revealing to note that 86 percent of lesbian women report that they usually or always orgasm during sexual encounters, in contrast to only 65 percent of heterosexual women.) Yet there were other men who knew exactly what they were doing, among them my future ex-husband, whom I met when I was 25 and who, from our very first night together, stunned me with his seemingly preternatural understanding of my clitoris. Paradoxically, it was the sheer intensity of our sexual attraction, the dawning hope that maybe one day he could make me climax, that not only triggered my frustration but also inspired me to act. In the early days of our relationship, I made—at a cost of $250—an appointment with a sex therapist, therein getting a glimpse of the growing and highly lucrative female-orgasm industry. A plump, elderly woman with an office full of gray tones advised me to eat more dark chocolate, stop taking birth control, and sign up for what she called “orgasm camp,” an immersive experience somewhere in the American Southwest that would have me masturbating all day long. She also sent me home with some female-centric 1980s porn, a list of recommended herbs and vitamins, and a prescription for Viagra that the pharmacist, alarmed by my gender, initially refused to fill. For months I dutifully followed her advice, masturbating daily, popping Viagra on date nights, enduring improbable narratives about sensitive plumbers with frosted tips and acid-washed jeans, and even going off the pill. (Orgasm camp was too expensive.) But although my sex life continued to thrill—to reiterate: Pleasure and climax are not synonymous for women like Lizzie and me—I still failed to come. Eventually, exhausted and even a little bit bored by the effort, I once again resigned myself to my anorgasmic fate. From the time that Aristotle first argued, more than 2,000 years ago, that only women “of a feminine type” ejaculate, the female orgasm has been the subject of a massive misinformation campaign. The Greek physician Galen, convinced that a woman’s reproductive organs were the exact inverse of a man’s, maintained that the female orgasm was necessary for procreation, a belief that lasted into the 18th century. (Galen also believed that women were immune to postcoital tristesse, clearly never having hung out by my bedside. “Every animal is sad after coitus,” he opined, “except the human female and the rooster.”) The ostensible correlation between pregnancy and female pleasure materializes again and again over the centuries, popping up in everything from a 13th-century British legal treatise to a guidebook for Renaissance midwives. But while you might think that this misconception would be to the medieval woman’s advantage, compelling her brutish husband to finally pay attention to her needs, it also offered a convenient defense for rape apologists, who seized upon the link between propagation and womanly lust to argue that nonconsensual sex could not possibly result in childbirth. (Or, as Republican Congressman Todd Akin so memorably put it in 2012, during his failed bid for Senate, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”) Not until 1730 was it finally proven that the female orgasm was not, in fact, a requisite for reproduction; only then did anatomists begin to develop a relatively accurate conception of female anatomy. Even so, it took at least another century for the German anatomist Georg Ludwig Kobelt to produce one of the earliest detailed diagrams of the clitoris, the only human organ built for pleasure alone, and one that, with more than 8,000 nerve endings, is decidedly not the inverse of the penis. You’d think, once again, that women might be the beneficiaries of such progress, but no: Coupled with the relegation of the female orgasm was the relegation of female desire, with the result that many Victorian doctors believed that women were actually incapable of climax. As the British gynecologist William Acton wrote in 1857, echoing the prevailing wisdom of his colleagues, “The majority of women (happily for them) are not very much troubled by sexual feelings of any kind.” Rachel Maines, a historian of technology, has argued—speciously, some scholars say; more about that in a moment—that around this same time, pelvic massage became a profitable enterprise for doctors seeking to cure their female patients of “hysteria,” the symptoms of which were said to include anxiety, sexual desire, loss of sexual desire, and a general predilection for troublemaking. The history of this nebulous “disease” (the American Psychiatric Association wouldn’t abandon the diagnosis until 1980) stretches way back, as does the practice of massaging women to better health—good old Galen tells the story of an afflicted widow who was advised to rub her “female parts” with “customary remedies,” thus eliciting the “pain and pleasure” that traditionally accompany intercourse. By the mid-1800s, Maines writes, hydriatic massage (of the sort my 11-year-old self would later discover) was developed, and some European spas had high-pressure jets specifically designed for treating “female disorders.” And yet, because it was understood by then that women were unequipped for sexual excitement, the results of such treatments were known not as orgasms but as hysterical paroxysms. Maines also suggests that we have this history to thank for the creation of the vibrator, which was patented in the 1880s in England—well before the vacuum cleaner—as a labor-saving device for doctors who had been complaining of chronic hand fatigue. Other historians have disputed Maines’s claims, citing myriad discrepancies between her source material and her conclusions, and they lament that her work—which has made its way into countless books, films, scholarly articles, and even a Broadway play—has gained such widespread acceptance. Indeed, as I discovered while researching this essay, Maines has so completely shaped the discourse around sex and technology that it’s difficult to discern where the truth of physician-assisted paroxysm actually lies. Nevertheless, there’s no doubt that home use of the vibrator took off quickly, with advertisements for “The Little Home Doctor” and “Aids That Every Woman Appreciates” appearing in such mainstream publications as Popular Mechanics, Woman’s Home Companion, and the Sears and Roebuck catalog. (While vibrators would eventually lose the imprimatur of social acceptability, they gained traction again on the heels of the women’s movement, not to mention the Rabbit’s cameo on Sex and the City. By 2009, some 53 percent of American women admitted to having used a vibrator at least once in their life.) With the 1953 publication of Alfred Kinsey’s pioneering research, Sexual Behavior in the Human Female, which included the revelation that 62 percent of American women had masturbated, the Western world finally embarked upon a period of relative sexual enlightenment—what Jonathan Margolis, the author of O: The Intimate History of the Orgasm, calls “the unsteady Western path from Victorian hangover to cautious advance.” Since then, much of the discussion around the female orgasm has centered on the evolutionary mystery of why it exists in the first place. Indeed, the male and female sexual organs would appear to be very poor complements: as a surprisingly large number of men and even women seem not to realize, the physical location of the clitoris means that only about one-fourth of women, according to some estimates, are able to achieve orgasm from penetration alone. Which raises the question of why, evolutionarily speaking, women climax at all. Or, as Stephen Jay Gould wondered in 1987, “How can sexual pleasure be so separated from its functional significance in the Darwinian game of life?” Perhaps the most widely accepted theory of the female orgasm belongs to Desmond Morris, the author of The Naked Ape, who hypothesized in 1967 that the relative difficulty men face in bringing a woman to climax is the very point—or, as Margolis explains it, that the kind of man who devotes the necessary care to pleasing his partner is the same kind of man who will stick around to help her raise their children. Other views abound, however, including the controversial “upsuck theory,” in which the cervix in orgasm draws sperm toward the uterus, and the American anthropologist Donald Symons’s nonadaptive argument, put forward in 1979 and later embraced by Gould, that the female orgasm—much like the male nipple—is simply a vestige of the sexes’ parallel embryonic development. A 2019 study involving rabbits and Prozac gave new credence to yet another theory, one suggesting that the female orgasm dates back to some prehistoric era in which ovulation was triggered by sexual intercourse. (In bunnies, it still is.) The truth is that no one knows for sure why women come, and our descendants may well look back on such theories with as much derision as we do on the treatment of hysteria or the tie between climax and pregnancy. The female orgasm is a kind of Rorschach test—an abstraction upon which each new generation of doctors and scientists can project its worldview, almost always to the benefit of men and their assumptions about normally functioning female sexuality. But if you think the debate over why women have orgasms is complicated, try solving the mystery of why some women don’t have them. [Wednesday Martin: The bored sex] Some nine years after my appointment with the sex therapist, newly single after my divorce, I found myself on the floor of a Williamsburg apartment, white headlights from the expressway every so often sweeping across my bare skin. It was my fifth date with Chris—I’ve changed the names of all friends and lovers in this essay—and we’d just had sex for the fourth time in 12 hours. I was already beginning to fantasize about our future together when he abruptly confessed that he was bothered. “For me, sex is goal-oriented,” he explained. “I know I won’t be able to enjoy it if I can’t make you come, if we can’t share that next-level connection. If I had been your husband,” he added helpfully, “I would have had you seeing the best sex therapist out there.” I felt suddenly enraged, as well as a little naive. I had freely shared my truth with him, as I had with all the men I’d dated; I think I’d even been proud of it, as if it were a mysterious twist that set me apart, a sexy secret, like tuberculosis, that he and I might grapple with together. “But can’t you see how unfair that is?” I said. “If I’m having fun, if it feels great to me, why can’t you just trust in that?” He demurred. “I’m just not sexually compatible with someone who isn’t able to let go.” And then: “I think it’s probably insurmountable.” That’s when I realized that my new role as a divorcée would force me to confront this issue all over again. Indeed, my ex-husband’s impressive self-regard may have spelled the end of our marriage, but it had also been delightful in the bedroom—here was a man, brimming with confidence, who had never once seen my predicament as a challenge to his masculinity, and who had always believed me when I told him, truthfully, just how much he turned me on. But for the men who followed, my condition was a turnoff, a defect that rendered me not only less of a woman but actually undateable. With no one was this clearer than with Michael, a guy I nearly relocated for. One year after the collapse of our relationship—we were lying naked in his bed for old time’s sake—I asked him why he thought that things had not worked out for us. “If you had moved here,” he said, “we probably would have gotten married. And to be totally honest, if I were married to a woman who couldn’t come, I’d probably cheat on her.” I was dumbfounded by his answer. It would have been one thing if he had said that he didn’t find me funny or attractive or intelligent, or that he’d sensed we wanted different things from life. But to drift away because I couldn’t orgasm, a fact that I’d accepted, and one that had nothing to do with my attraction to him? It seemed so horribly unjust. “You have to understand how much I love to pleasure women,” he continued as I raved and ranted. “I think it’s the closest connection two people can share, and I think I’m really good at it—I’ve tried to turn it into an art; I’ve actually studied it.” (That I believe; the vigor he used to bring to his various sexual exertions had always reminded me of someone showing off a party trick.) “So the idea of marrying someone who will never have an orgasm,” he reasoned, “of never again being able to get a woman off, is really hard for me.” He paused. “I don’t know, maybe there’s a way in which I could see it as a challenge, like getting to a really high level in a video game. But it doesn’t feel like that.” In David Foster Wallace’s short story collection Brief Interviews With Hideous Men—one of the more incisive critiques of contemporary masculinity I’ve come across—interviewee No. 31 offers up a useful lens through which to consider our society’s current obsession with the female orgasm. Of course there are the “basic pigs,” he argues, the ones who “roll on and roll off” with absolutely no regard for their partner’s pleasure, but there’s also a second variety: the ones who believe they’re a “Great Lover,” putting a notch on their gun for every female climax they facilitate. “It’s real important to these fellows that they think of themselves as Great,” he explains. “This preoccupies a major block of their time, thinking they’re Great and they know how to please her.” I know such men—they keep coconut oil and vibrators in their bedside drawers; they could find your perineum while wearing a blindfold; they call the upper-left-hand quadrant of your clitoris the sweet spot. “But now don’t go thinking these fellows are really any better than your basic pigs are,” the interviewee cautions. “They think they’re generous in bed. No, but the catch is they’re selfish about being generous. They’re no better than the pig is, they’re just sneakier about it.” In her 2018 book, Faking It, the sex educator Lux Alptraum denounces a culture in which, for many men, the female orgasm has become “the primary, if not entire, purpose for pursuing sex—a sentiment that suggests that anyone who isn’t able, or doesn’t want, to achieve orgasm is some kind of freak or failure.” Alptraum lays no small amount of blame for this on She Comes First, a wildly popular cunnilingus manual by the sex therapist Ian Kerner, which, when it was first published in 2004, was lauded by magazines such as Jane and Cosmopolitan for its promotion of female pleasure. (The Great Lover, Wallace’s interviewee notes, is always “running down to Barnes & Noble’s for all your latest female sexuality-type books so they can keep up on their knowledge.”) And yet for all its noble pretensions, Alptraum argues, Kerner’s book established a new paradigm in which the female orgasm, once seen as mythic, was recast as compulsory. Indeed, the trouble with She Comes First, Alptraum says, is that it positions the female climax “as a badge of honor and proof of a man’s virility, rendering women’s actual needs, desires, and authentic pleasure subordinate to the appeasement of the heterosexual male ego.” In search of an expert male perspective on this debate, I went to see Ian Kerner himself. His tasteful office in Manhattan’s West Village was full of Danish modern furniture I would have chosen for myself. Over espresso, he rejected the idea that She Comes First had cast the looming cultural shadow Alptraum proposes, as well as the notion that a majority of men treat the female orgasm narcissistically as sport. If anything, he said, men who fixate on their partner’s anorgasmia are likely grappling with feelings of inadequacy, adding that no one in his practice had ever left a woman because she couldn’t come. “It can be an issue for a male who feels hurt or wounded—it’s not so much his ego, as much as a feeling like, Sex isn’t fun for this partner.” But Kerner also conceded that his thinking has evolved in the years since She Comes First, thanks in part to women like Alptraum and their appeal for a more inclusive view of female sexuality. These days, he said, he works with plenty of couples “who are very motivated and incentivized to have sex without orgasm. Part of my work—which is in contrast to She Comes First—can be really enjoying all the parts of sex.” After listening to my story, Kerner hypothesized that my particular problem was an inability to quiet the restive, self-conscious parts of my brain. “To what degree are you staying in an observational place in your own experience,” he asked, “as opposed to being able to drop down into an experience of arousal?” He told me about a 2006 study by the Dutch neuroscientist Gert Holstege in which 12 women reclined with their heads in a PET scanner while their partners brought them to orgasm; much to Holstege’s surprise, the scans showed a dramatic drop in activity in the amygdala and prefrontal cortex, parts of the brain associated with anxiety and inhibition. “So the conclusion of Dr. Holstege,” Kerner explained, was that “for a woman’s brain to get turned on sexually, another part of the brain has to turn off.” If I were Kerner’s patient, he said, he would champion a psychogenic approach, trying to sink down into an arousal state rooted in fantasy and touch. “It’s allowing your mind to get really turned on,” he said, “and maybe there’s a sort of tipping point where all that anxiety is vacated.” Yet he also admitted that this—willfully disabling one’s amygdala—is easier said than done. [Read: Why are young people having so little sex?] I do understand that there’s a sense in which I’m being disingenuous, insisting on how absolutely and completely I love sex when it is also true that I am frustrated, that I do wish—desperately at times—that it were not always for me an anticlimax. If Kerner is to be believed, moreover, there may be some validity to the critique that I’m unable to let go—I think it was Chris who said he had the sense that I was watching him during sex, trying to gauge whether he was enjoying himself rather than being transported myself. And finally I understand, too, having recently dated a man who himself struggled to come, why that can feel unsatisfying and humiliating to one’s partner; much of the thrill of sex is not pleasing the other person but being able to please the other person. And yet it still makes me angry when I think of those exchanges with Chris and Michael, of their paternalism and hypocrisy. They are not hideous men, and my guess is that they see themselves as feminists, or at the very least enlightened, devoted above all to the satisfaction of their female partners. But their refusal to accept my own account of my experience—their insistence that, no matter what I said or did, I was not enjoying myself, or not enjoying myself enough—belies this narrative, makes it clear that their preoccupation with the female orgasm had very little to do with my pleasure and almost everything to do with their own. That’s why I still prefer the more overtly selfish men—the “basic pigs,” if you will—the ones who don’t particularly care if it was good for me, and who would never seek to mask their insecurity and egotism as a desire for human connection or concern about their partner’s happiness. At least they’re being honest about it. Which is something I stopped being. In the weeks and months after that conversation with Michael, still traumatized by his rejection, I finally embraced the obvious solution: I started faking it. Perhaps you are dismayed by this confession; certainly it made my friends uneasy. They worried about my endgame, about the surrender of my sexual agency, about the fact that all my future relationships would now be built on a lie. “Forget those clowns,” they said of Chris and Michael and others like them. “You need to find a man who accepts you for who you really are.” Sex therapists dislike it too; they think that faking it breeds guilt and resentment, and that fixating on performance instead of pleasure makes sex even less enjoyable. (They also recognize how common it is, a fact that many men don’t seem to grasp. When Chris, who had slept with well over 100 women, swore to me that I was the first he couldn’t bring to orgasm, I laughed out loud.) But the truth is that, for me, faking it was instantly empowering, even revelatory. Overnight, the emphasis shifted from what I lacked to what I offered (everything from a genuine zeal for blow jobs to an extensive toy collection). Sex was suddenly more fun, less fraught, and I came to luxuriate in the kinds of responses I imagine most orgasmic women had been receiving all along. Far from hiding who I really was, then, faking it threw into relief my sexuality; for the first time since my divorce, maybe for the first time ever, men began to see me as I saw myself, and as I knew myself to be, which is to say, no less carnal than the next person, and perhaps even more so. Sure, there were some ethical and practical issues at play—it pained me to think of a man I loved learning that I had deceived him; what was my endgame?—but I also couldn’t help feeling that it was finally my turn to be selfish. But the sexual excitement sparked by this discovery sparked sexual frustration too. One weekend at my mother’s house, I realized that the guy I was seeing had forgotten to take his boxer briefs home after visiting; I spent the next morning wearing them around my bedroom, staging erotic photo shoots as sext fodder, and turning myself on so much that in desperation I finally grabbed an immersion blender from the kitchen, praying that its whirring handle might function either like the man who’d left behind his underwear or like the vibrator I had left behind in Brooklyn. It didn’t—its spinning blades were far too close for comfort—and I can remember almost crying with vexation; it’s hard to convey the impotence I felt at being unable to do anything with all this pent-up carnal energy, at being 37 years old and still having failed to master my own body. And so I resolved to continue on the journey I had started with the sex therapist all those years before, first googling orgasm camp to no avail and next setting up an appointment with Dr. M, a sensual-touch therapist whom I had read about in New York magazine. (Optional donations appreciated.) A few weeks later, I met Dr. M—“Not a real doctor,” he admitted needlessly—at a Starbucks near his apartment. An average-looking man in his 40s, he had a pleasant energy and a wry sense of humor; we made small talk as he escorted me through the service entrance of his building and into his small, anodyne bachelor pad. (You know the type: brown-leather couch, black IKEA bookshelves, navy bedspread, oversize poster of the Brooklyn Bridge.) After a brief consultation on my sexual history—we had already spoken of it on the phone—I disrobed in the bathroom, wrapped myself in a towel, and lay down on his massage table. An oil diffuser morphed soothingly from green to purple, releasing a fine eucalyptus mist, and ambient music droned softly in the background. As he rubbed my neck and arms, I strained to read the titles on his bookshelf; I thought that I could just make out The Case for Israel. Eventually he poured warm oil onto my back and, still rubbing, slowly began to pull apart my legs. It was exciting for sure—I couldn’t tell you what exactly he was doing, but it felt melty and cadenced and new. “Good girl,” he said encouragingly whenever I squirmed. He had cautioned me earlier against being too goal-oriented, and I tried hard to empty my mind of any thought of orgasms. I don’t think I actually expected one, but it was nearly impossible not to latch on to each new sensation--Will it be now? Will it be now?—in a way that surely made the prospect far less likely. (“Try not to think of a polar bear,” Dostoyevsky said, “and you will see that the cursed thing will come to mind every minute.”) “Okay,” Dr. M said at last. “We could keep going, or else we could finish up with a little Magic Wand action.” “What’s that?” I asked. “This bad boy here,” he said, unfurling something that looked an awful lot like my mother’s blender. A few minutes later, the towel had fallen to the floor and I was writhing naked on the table, at once enthralled and repelled by the Magic Wand’s pulsating tip and casting about desperately for something to grab hold of. “Is it okay if I touch you?” I asked, already seizing his free arm with both hands. “Of course,” he said kindly. It was less than an hour since we had first shaken hands at Starbucks. As I later told my friends of the experience, it was probably the best that any man’s fingers had ever felt; if I were a woman who orgasmed, I said, I would have had at least three of them. But as I could have predicted, and as Dr. M himself noted—I was beginning to feel as if he were a real doctor, so dedicated was he to my cause—something appeared to be holding me back, some inability to get over the hump. (“It seemed that you came oh-so-close,” he later wrote me in an email.) I dressed as he described his varied clientele—the nonorgasmic, yes, but also single women craving intimate touch, adventurous women tackling their bucket list, married women seeking sexual pleasure without cheating. (Without cheating? I thought. Hmmm …) “So you’re off to your date?” he asked as he opened the door. On our walk, I had told him about the retired merchant marine officer I was meeting for dinner. “I am,” I said. “But I have some time to recover.” “Okay, then,” he said, laughing. And then, holding out his arms like someone’s dad: “Big hug?” If, like me, you can’t resist the urge at cocktail parties to recount your sexual adventures—the allure of a good story trumping any concerns you may have about puncturing your own sexual mystique—you will soon find yourself inundated by a flood of orgasm-related advice. One friend, a therapist, thought hypnosis was the next logical step, while Michael—yes, that Michael—suggested I get involved with OneTaste, a now-defunct “orgasmic meditation” company selling classes in which men wearing lubricated plastic gloves fondle a woman’s clitoris for 15 minutes straight ($499 for a weekend course; $60,000 for a year-long membership). Another friend had enjoyed the late sex educator Betty Dodson’s Bodysex workshop, a 10-hour female-masturbation class in which you sit naked in a circle, play with weighted dildos, and examine the vaginas of your fellow workshoppers in a “Genital Show and Tell” ($1,200 by check or $1,000 by cash; complimentary vaginal barbell included). Ian Kerner recommended that I check out the New Society for Wellness, an elite New York City–based sex club for Millennials ($1,690 a year for unlimited access to cannabis-friendly sex parties featuring fire performers and domination by professionals), as well as the Body Electric School’s clothes-off retreats ($495), offering a sanctuary in which to “become more aware of spiritual dimensions in your erotic explorations.” He also mentioned OMGYes, a series of instructional videos that break down taboos about women’s sexual pleasure ($59 for one season or $118 for two), and Mama Gena’s School of Womanly Arts, which sells a curriculum for “sister goddesses” by the best-selling author of Pussy: A Reclamation that can be yours for upward of $5,000. Meanwhile, Dr. M suggested two additional resources: an online “Finishing School” by the sex therapist Vanessa Marin, whom BuzzFeed christened the “orgasm whisperer” (four payments of $179 or a single payment of $999), and a New York–based wellness clinic called Maze Women’s Sexual Health. In a free, 10-minute phone consultation with the latter, I spoke with a lovely woman named Jen. As she described it to me, my involvement with Maze would entail a 90-minute initial visit with a therapist and a gynecologist ($530 before insurance; bloodwork included), and then an indeterminate number of follow-up visits ($380 for the second visit and $250 for each appointment after that, before insurance; additional testing not included) designed to target my particular issue, most likely with some combination of the following: an assortment of creams designed to increase clitoral sensitivity; access to no less than 20 different kinds of vibrators; a collection of ethical, female-generated pornography; testosterone-replacement therapy; a prescription for Wellbutrin; and the O-Shot, a new treatment in which blood taken from my arm would be centrifuged, its platelet-rich plasma separated out, and then injected into my vagina. This deluge did not spark joy; on the contrary, it left me confused, even despairing. Where to start? And how to pay for it? I might have simply given up as I had a decade earlier; certainly I approached each opportunity with skepticism, doubtful that any of them would actually work. But one by one, their websites—sophisticated, knowledgeable, seemingly so sympathetic to my plight—began to lure me in; I felt guilty at the prospect of inaction, as if failing to part with a huge chunk of my savings, not to mention all my leisure time, were somehow an abrogation of my responsibilities as a woman. Which was of course the point: For all my excitement and curiosity about vaginal barbells and the O-Shot, I was still sane enough to recognize that, regardless of their good intentions, these outlets were to some extent a mirror of the very men who’d sent me on this wild-goose chase in the first place, the ones who’d cloaked their own self-interest in ostensible concern about my satisfaction. Vanessa Marin had worked with innumerable women who feared their partners would dump them because they couldn’t come, a reality she clearly found heartbreaking and validating to her life’s work as an orgasm whisperer. Yet I couldn’t help feeling that in her effort to empower these women, she had also inadvertently perpetuated the very notion that had been ingrained in them by the men who threatened to leave: that they were somehow inadequate, that their pleasure wasn’t enough. [Dear Therapist: My husband and I don’t have sex anymore] Nor was I alone in the guilt and anxiety I felt at confronting this glut of self-improvement options. There’s no end of means by which women, even orgasmic women, are conditioned to doubt their own normally functioning sexuality, as well as pressured, at considerable cost, to take steps toward “fixing” it. Perhaps most pernicious is Big Pharma’s pursuit of a female equivalent to Viagra and concomitant financing of programs to spread awareness of female sexual dysfunction and hypoactive sexual desire disorder, which paved the way for products such as Addyi, the controversial “little pink pill” that gained FDA approval in 2015. Addyi’s labeling describes HSDD as being marked by “low sexual desire that causes marked distress or interpersonal difficulty,” a phrase that, as Georgetown University Medical Center’s Dr. Adriane Fugh-Berman observes, speaks volumes about the drug’s true beneficiary: “So a woman upset by a belittling spouse who wants sex more often than she does,” she asks, “is eligible for a prescription drug?” Fugh-Berman has written at length about HSDD’s history, arguing that “there is no scientifically established norm for sexual activity, feelings or desire, and there is no evidence that hypoactive sexual desire disorder is a medical condition.” Rather, she maintains, HSDD is an illustration of “a condition that was sponsored by industry to prepare the market for a specific treatment.” Which in turn would mean that untold numbers of healthy women are risking side effects such as nausea, dizziness, and low blood pressure so as to cure a subset of female sexual dysfunction that doesn’t exist in the first place. (Sprout Pharmaceuticals, the manufacturer of Addyi, has said that HSDD is a real condition, noting that the FDA has recognized female sexual dysfunction as “an important unmet medical need.”) “There are dozens of medications in the pipeline that want to give women a version of desire that’s really a media-concocted version of desire,” Kerner told me. “It’s saying, ‘Hey, if you’re not experiencing desire in this forthright way, you might be a little broken, and here’s a pill.’ But it’s sort of a strawman argument because you’re creating a problem to then fix.” One of the most incisive observers of the female-orgasm industry is Jen Gunter, an ob-gyn who is renowned for tearing down insidious myths about female sexuality--Goop’s jade eggs and vaginal steaming, certainly, but also the O-Shot, which is “so many layers of horrific,” she writes in her book The Vagina Bible, “it’s hard to know where to begin.” When we spoke by phone, Gunter had me in stitches at her description of our fetishized portrayal of female desire. “The whole sex industry,” she said, “it’s all about the female orgasm, in the sense that it’s not about the pleasure that gets you there. Patriarchal society wants women to be horny for men when the men are ready; it’s like, ‘Of course, oh mighty sword bearer, you should be able to just twist a nipple and stick it in, and in three seconds I’m going to arch my back and act like the most pleasurable thing in the world is happening to me.’” She said her two teenage sons have started walking out whenever there’s a sex scene in a movie or an episode of Game of Thrones because they’re so sick of her counting down the seconds from penetration to climax (“Oh my God, stop it, Mom!”). But she argues that the consequences of such messaging can seriously affect women and weigh on them, and she sees a lot of patients whose partners have broken up with them because of their sex life. “There are countless different ways that women’s sexuality can be weaponized against them,” she told me. “Pick a way, and it exists.” In the end, I made an appointment with a tantric healer ($600 for two hours, not including travel time) recommended by my friend Imogen, another woman in her 30s with climaxing issues. “You need to see this guy,” she texted me one afternoon. “I had the lobster-claw full-body orgasm experience. It was so insane.” And then, when I asked if the healer had actually touched her—I knew nothing about tantra, but I had visions of hands trying to manipulate the energy half an inch above my skin, which clearly wouldn’t cut it—she responded with a simple “Yup.” The next thing I knew, I was opening my door to Justin, a tanned, muscular man about my age wearing combat boots and maroon-and-yellow ikat balloon pants. We sat in my living room discussing the lengthy intake form I’d sent him—“Do you love your genitals? Please describe”—and arguing good-naturedly about whether my having survived a near-fatal car accident a few years back meant that I had been put on this planet for a purpose. (He said yes; I said no.) He struck me as intelligent and oddly down-to-earth, given his wacky spiritual bent; I felt as safe and comfortable with him as I had with Dr. M. Then he asked me to take off my clothes, don a sarong, and make a list of intentions to tuck beneath the mattress as he prepared the bedroom for our session. “Let’s see what you came up with,” he said when he emerged. “You’re going to read them?” I asked. “I thought they would be private!” “Listen, you’ll be doing a lot of private things today,” he said, “but you’ll be doing them with me.” We were sitting at my dining table now, him fully clothed and me essentially naked, the semi-transparent sarong wrapped around me like a towel. Every so often he took a break from reading my intentions to offer pearls of wisdom: Get rid of your vibrator. Make masturbation a weekly ritual. Study your vagina in the mirror (“Like Charlotte in Sex and the City!” I exclaimed to his chagrin). Most important, stop faking it. “How will you ever find something authentic if you’re inauthentic from the start?” he asked. “And if a guy does bolt for that reason, that’s an excellent way of weeding out the assholes.” “Let’s talk about boundaries,” he finally said. “I don’t think I really have any?” “Okay then,” he said. “Would you be all right with unprotected penetrative sex?” “Oh!” Chastened, I added: “No, I guess not.” “See, that’s a boundary,” he said, and offered up a long list of other erotic possibilities. It was beginning to dawn on me that tantric healing was a little more, um, hands-on than I had realized; aroused, I said yes to it all. Then he disappeared into the bedroom. When he opened the door, he was wearing only yellow silk shorts and his many amulet necklaces. The blinds were lowered, the bed strewn with rayon rose petals; incense smoldered on the dresser, and dozens of electric candles did their simulacra of flickering. “Enter, Goddess,” he said solemnly. We sat cross-legged on the bed, holding hands and looking into each other’s eyes; he told me to breathe deeply in through my nose and out through my mouth. Then I lay on my stomach as he pulled off the sarong and massaged my back and legs; when he later straddled me, running his forearm horizontally up and down my spine, I realized with a jolt that he also was naked. If I kept my eyes closed, I could almost ignore the question of whether I had inadvertently hired a prostitute. “You are strong,” he whispered, every so often nibbling my earlobe. “Beautiful. Sexy. Worthy. Loving. Lovable.” He rubbed his hands with lavender oil and told me to inhale. “Imagine the farm where this lavender was grown,” he said, “and the factory where it was turned into oil. Imagine the farmer who picked it; imagine his life, his preoccupations and joys and anxieties. The world is performing for you,” he said. “Think of everything it’s doing behind the scenes to support you, and you don’t even realize it.” Then he stuck his finger in a place that I’ll keep classified. When it was all over—let’s just say that there was lots of attention lavished on my “sacred temple,” lots of sighing over what he called “the nectar of the gods”—Justin flipped me on my side and we began to spoon (so that our heart chakras were aligned, naturally). “You are a goddess,” he told me again, “and I acknowledge and honor you.” He was shocked to learn that I hadn’t come, given my seeming enjoyment, and he wondered aloud whether I actually had, whether there was some block between my body and my brain. We turned to face each other, still lying naked and entwined. “You have the weirdest job,” I said. He laughed, but not because he agreed with me. “It’s a calling,” he said. “I truly believe that tantra will be the next big thing, like yoga or meditation.” He told me how revelatory his first tantric experience had been; how he had sold his fancy car and quit his finance job; how he had moved to Miami so he could focus on healing women like myself. He talked for so long that the afternoon shadows began to lengthen—I hadn’t hired a prostitute, I realized, but a boyfriend. That evening, as instructed, I drank lots of water and set light to my intentions, which quickly curled into a scroll of velvety soot. I also texted Imogen: “I really want to discuss the intimacy of it. Afterward we lay in bed naked holding each other and talking for half an hour as if we were in love.” “He held me at the end too like a baby,” she wrote, “but I was paralyzed at the time so maybe it didn’t feel romantic to me.” Justin texted as well, to ask how I was doing, and whether I’d had any further revelations. I think my answer disappointed him, for he soon texted again: “There may be more lessons or teachings you have created for yourself in this experience than you are letting yourself see … Don’t sell yourself short on how much you accomplished … This is a journey and you are just at the beginning.” Is that true, that my journey is only just beginning? Some days I think I’m finished searching for my orgasm; other days, feeling more hopeful, I consider asking my mother for a masturbation workshop for my birthday. Yet other days, I wonder whether I’ve actually been having orgasms all along, whether the occasional spasms I feel are the real thing. As Lux Alptraum points out, the female orgasm is often more difficult to pinpoint than its male equivalent, and underwhelming climaxes, oxymoronic as they may sound, are far more widespread than we think. In O, Jonathan Margolis describes a study in which the sex researchers William Hartman and Marilyn Fithian observed a group of women who believed themselves to be anorgasmic, but three-fourths of whom, as it turned out, had been demonstrating physiological reactions consistent with orgasm all the while. “It is as if the modern mythology and cult of orgasm,” Margolis writes, “has placed the sensation on such a pedestal—created such an aspirational ‘superbrand’ of it—that women perfectly capable of orgasm refuse to believe they are having a legitimate one.” Vanessa Marin, the orgasm whisperer, recently endeared herself to me by releasing a free video series called The Female Orgasm Revolution that I’ve been watching and rewatching like a cultist. (Did you know it takes women an average of 20 minutes to come? Or that 85 percent of men thought their female partners had climaxed during their most recent sexual encounter, whereas only 64 percent of women said they actually had?) Vanessa thinks it’s bullshit that 10 percent of women are destined for inorgasmia, by the way, and so too the idea that orgasms require simply “letting go.” Orgasm is a skill like skiing, she says, and like skiing, it calls for time and practice. Last night in bed I attempted her celebrated four-step masturbation method, a combination of stroke, speed, pressure, and body techniques—it left me longing for the Magic Wand, but she would say that’s just my impatience talking. At least she’d be pleased to know that my days of faking it are over, if only because, driven by the same storytelling compulsion that motivates me at cocktail parties, I’m almost certainly blowing my cover. But maybe it’s for the best. Granted, I surprised myself with the ire that bubbled up over the course of writing this essay; I hadn’t realized how much lingering resentment I had toward those men—and later, toward the female-orgasm industrial complex in which I saw the self-interest of such men reflected—who made me feel deficient and ashamed for a situation out of my control, and one that I had long ago made peace with. As grateful as I am to Dr. M and Justin for their support, moreover, for offering a safe space in which to further explore the frontier of my own body, I find myself wondering, when I think too hard about it, whether their professed “calling” is actually just more male selfishness in disguise. (“Do you work with men?” I asked Justin before he left. “No, only women,” he said. “I’m not trained in the lingam.” Shocking, I couldn’t help thinking.) Yet I refuse to believe that there aren’t at least a few men out there with the necessary confidence and generosity to want me regardless of whether or not I ever come, and Justin made a good point: How will I ever find something authentic if I am inauthentic from the start? And I will leave you there, dear reader—with the frustration of yet another anticlimax. from https://ift.tt/3no5lBn Check out http://natthash.tumblr.com At the LGBTQ senior community where John James lives in Philadelphia, residents keep busy with trips to the garden or—before the pandemic—screenings of Strangers on a Train in the rec room. James does not care for any of that right now. Each morning, he combs through medical-research databases and downloads every paper he can find on COVID-19 treatments, scribbling notes about the parts that stand out. Most days, he reads papers at his desk until 1 a.m. Besides research, “there’s not much else I do in the day,” he told me. “I’m 79. I’m retired. I want to do things that are serious.” All of his work is in service of a website he recently launched, called COVIDSalon: Treatment Options. He updates it nearly every day, tracking the highest-profile and most promising COVID-19 drugs. It’s an old-school, text-heavy site, with reporting about drug trials, links to outside resources, and overviews of medications in the news all stacked onto a single page. Few people understand the value of tracking treatments better than James. In 1986, when gay men across the country were dying from AIDS and were desperate for guidance, James began publishing updates on experimental-drug trials in a newsletter he called AIDS Treatment News, or ATN. James is not a doctor, and he is not HIV-positive, but during his time working as a computer programmer at the National Institutes of Health in the early 1960s, he learned to read medical research and interpret statistics. Despite operating on a tiny budget, ATN became one of the primary news sources for the queer community. In 1991, The New York Times noted that ATN was the newsletter “most frequently cited” by doctors and people with AIDS alike as their main source for drug news. Congress even referenced the newsletter in a report on AIDS therapies. With the coronavirus pandemic, James sees treatments slipping under the radar once again. While the federal government poured $18.5 billion into vaccine research, only about $8.2 billion went to treatments. One drug that has gotten a lot of attention, hydroxychloroquine, has largely proved to be a dud. Even though half of all American adults have received at least one vaccine dose, research on COVID-19 treatments remains vital; tens of thousands of Americans are still hospitalized with the coronavirus, and better treatments might help them. Meanwhile, for COVID-19 long-haulers dealing with lingering effects of the virus, treatments may offer the best hope of a return to normalcy. With COVIDSalon, James is leaning into a notion that he and other veterans of the AIDS epidemic helped trailblaze in the ’80s: Patients can become experts on their own disease, and that starts with supplying them with the right information. When James launched ATN, the situation was dire. In 1985, 8,406 Americans died of AIDS, nearly doubling the number of deaths from the year before. But few drug trials for AIDS were under way, and those that were rarely received mainstream coverage. Because doctors didn’t know how to treat the new disease, people with AIDS needed to research their own symptoms and, sometimes, plot their own course of care. Activist groups such as ACT UP “really promoted the idea of Let’s get this [treatment] information out there,” says Patricia Siplon, an AIDS activist and a political-science professor at Saint Michael’s College, but few people had the time or the ability, before the internet, to do the research. With the queer community left in the dark about how to address the epidemic, James started accessing a dial-up computer database that hosted new treatment research as well as reports from the FDA and drug companies. Every two weeks, he would condense his findings into a two-page newsletter. After his newsletter started getting traction, James turned his San Francisco apartment into a makeshift newsroom. He and an assistant made copies a few blocks away, and mailed them out to subscribers one by one. Volunteers edited, fact-checked, and produced the newsletter at all hours. “When I needed to get to sleep at night, if they were still working, I would put a piece of cardboard over my face to block the light,” James said. He broke major news stories, including one about a steroid hormone, and directed people with AIDS to research trials, in which they could enroll and access experimental drugs. ATN became the go-to source for lots of people looking for treatment news: By the early 1990s, the newsletter had amassed more than 7,500 subscribers, including both people with AIDS and medical professionals, powered by a staff of five plus James. Even after the highly effective “AIDS cocktail” arrived in 1996, James turned his focus to the steep cost of the available drugs before finally shutting down the newsletter in the summer of 2007 to work on other research. Compared with treatment research at the height of the AIDS crisis, the state of COVID-19 treatment research looks very different. “It’s like comparing a drought to an avalanche,” James said. Much of the medical community has swerved to battle the pandemic, and doctors are testing more drugs on a faster timeline than ever before, says David Fajgenbaum, a doctor at the University of Pennsylvania who runs the CORONA Project, a database that catalogs COVID-19 drug trials. He told me that more than 400 different drugs have been given to patients, but only a small number of treatments, such as dexamethasone, have shown consistent signs of effectiveness against COVID-19. Most of the other treatments haven’t had the funds for extensive trials, and without proper research, some drugs run the risk of getting overhyped based on limited information. “The early bets financially were made on investing in vaccine trials and investing in monoclonal antibodies,” Fajgenbaum said. “What received relatively less funding and attention were drugs that were already FDA-approved that could be repurposed for COVID.” With so few treatments available to patients, James felt an obligation to explain where the research on those hundreds of other drugs stands. Just like ATN, COVIDSalon is focused on explaining treatment news for a general audience and helping sick people enroll in research trials if they want to. But it’s not quite a redux of ATN. People no longer have to wait for James’s twice-monthly newsletter to arrive in their mailbox to find out what trials are under way; they can just Google them. Instead, his goal with COVIDSalon is to provide a dedicated hub of treatment information so people don’t have to sift through a barrage of old articles. At the top of the site, James rounds up news stories about the state of treatments and peppers them with his own annotations. Below that, he gets into the repurposed drugs currently generating the most attention in medical journals. The obsessive-compulsive-disorder drug fluvoxamine “needs urgent attention from experts and the public,” James wrote in one update. One small trial in February found that 65 COVID-19 patients who took fluvoxamine did not experience any symptoms two weeks later. He has also mentioned inhaled budesonide, an asthma treatment, as another drug with early evidence of success against COVID-19. Many of the drugs that he has made a centerpiece of his site already have the attention of doctors such as Fajgenbaum, who said that both fluvoxamine and inhaled budesonide “look highly promising,” specifically for newly diagnosed patients. A large segment of COVIDSalon aims to help COVID long-haulers. At the moment, only a small number of trials are focusing on long-haulers, Fajgenbaum told me. James also highlights drugs like fluvoxamine that have alleviated long-term symptoms in a test of COVID-19 patients, plus others such as the nutritional supplement GlyNAC, which he suggests is worth watching but is still in very early-stage trials. The way that long-haulers have organized throughout the pandemic—discussing their symptoms in Facebook and Slack groups, and pushing medical professionals to pay attention to their ailments—echoes the patient advocacy that James helped popularize during the AIDS epidemic. Through publications such as ATN, many people with AIDS knew as much about the latest niche medical findings as licensed doctors did. “I think that’s the same with the long-haulers,” Siplon says, although she notes that the barriers they face are not entirely the same as the ones that people with AIDS dealt with in the ’80s. “Everyone is learning about the long-term consequences of this in real time.” COVID long-haulers are not waiting for scientists to come to them; they’re starting their own research groups, such as the Patient-Led Research Collaborative, which crowdsources people’s symptoms and experiences. James no longer has the influence that he once did; indeed, many long-haulers likely haven’t heard of ATN or even COVIDSalon. But the idea that people can become experts on their own disease runs deep in the work of long-haulers. The need for COVID-19 patient advocacy might become even more important as Americans get vaccinated and look to put the pandemic behind them. So, even when much of the country gets its first glimpses at normalcy, James said he’ll keep to his schedule of reading up on the latest treatment research. Though once it’s safe to, he’ll take just a few breaks to watch Strangers on a Train when it’s playing in the rec room. from https://ift.tt/3dJ1Hz2 Check out http://natthash.tumblr.com The coronavirus pandemic has led businesses and governments to perform “hygiene theater,” which can give a false sense of security. But how do we thread the needle between being too cautious and too cavalier? Derek Thompson joins James Hamblin and Maeve Higgins to help us understand. Listen to their conversation on the podcast Social Distance: Subscribe to Social Distance to receive new episodes as soon as they’re published. What follows is a transcript of their conversation, edited for length and clarity: Maeve Higgins: Can you explain what “hygiene theater” is? Derek Thompson: I would define hygiene theater as activities that might make you feel safer, but don’t actually make you any safer from the pandemic. A great example of hygiene theater—something that I did a year ago in March and April of 2020—was washing all of my fruits and vegetables with soap. I thought that’s where the virus lived. I thought it lived on apple skins and potatoes. And it just doesn’t really. I’ve written a couple of articles about how individuals, but much more importantly companies and even governments, have put too much weight on surface transmission of this disease: shutting down schools to clean the walls and the desks or shutting down the Metro or the subway so that they can wash down the seats. This is an utter waste of money and time, and time and money are scarce and important. And I think we should stop it. Higgins: Is it still kind of good that everyone’s taking care and being cleaner? Thompson: This is a totally valid argument. And I constantly find myself having to distinguish between what I think of as hygiene theater and other behaviors that are just fine and not that important. If people want to wash their hands constantly during a pandemic, I’m definitely not going to criticize that behavior. Washing your hands in order to get rid of bacteria is a fine, smart thing to do, pandemic or no pandemic. Hygiene theater is a problem for a totally different reason: At a conceptual level, we should be fighting this disease where it lives, and not telling people to fight this disease where it doesn’t live. People only have so much time in their day. They only have so much money. They only have so much cognitive capacity that they’re going to spend for this pandemic. We want to tell them the truth. And the truth is that this is basically an indoor, talking disease. You should be cautious when you’re indoors [and] especially cautious when you’re talking, but otherwise, this virus does not seem to spread very effectively. And so we should be encouraging people to go outside and not think so much about this disease living like bacteria on our kitchen table. If you think about urban-transit authorities, is it good that they’re cleaning the subway a little bit more than they might have been cleaning it years ago? Yeah, that’s totally fine. But in a period when the New York subway is running low on money and they’re having to shut down service at night, I don’t want them spending scarce money on blasting their subways and buses with antimicrobial weaponry. That is a waste of scarce resources. And it builds a false sense of security. In spaces like restaurants, if you see someone scrubbing down a table vigorously and think to yourself that means the restaurant is safe, the virus isn’t living on the table and that elbow grease is totally theatrical. What matters is ventilation in that restaurant, if you’re not vaccinated. I want people to focus on the threat this virus poses and to not focus on the threat this virus doesn’t pose. James Hamblin: We only have so much energy. We don’t want to feel like we’re getting credit for something that’s not actually doing anything. That leads into your argument about outdoor masking probably being overdone. Thompson: I was getting drinks with a friend last week and I did something that sort of struck me as kind of funny: I wore a mask while I was alone outside and then I de–masked up at this outdoor patio when I sat close to a person for two hours. From an epidemiological perspective, that’s kind of the opposite of what makes sense. This virus poses no threat to individuals walking alone down the street, but in close encounters and less ventilated spaces, it is more dangerous. It felt like wearing a seat belt in a parked car and then unbuckling the seat belt just as I put the car in drive. It felt like doing the opposite of what safety precautions should dictate. So I wrote this piece essentially pointing out, based on lots of research, that this virus does not seem to spread very effectively outside and we should probably think about very soon lifting outdoor mask mandates while encouraging vaccinated and unvaccinated people to wear their masks in public indoor spaces. I want people to live their life as normally as possible while protecting themselves as reasonably as possible. And I think the way to do that is: masks inside, masks in crowds, no outdoor mask mandates for people just living their life outside. Higgins: If hygiene theater is what we’ve maybe been overdoing, what haven’t we been doing enough of that we should probably do more? Thompson: I’m really glad that you asked that. I think people listen to me and [often] they’re like: Oh, you don’t take the pandemic seriously. And I do. I just conceptualize of this pandemic very specifically. It’s an indoor, talking disease, for the most part. If you are talking or breathing inside in an exerted way, like at the gym, that’s where the threat is. I think that people have sometimes had a really backward idea of what they should be doing inside. I wrote this piece last summer about library rules for America. We should have signs on places like CVS or Trader Joe’s that say: Please Keep Your Voice Down. This disease truly does spread through the aerosolization that comes from our talking. So people who go into CVS with their masks on and then pull down their mask to talk more clearly into [their cellphone] have completely misunderstood how this virus works. Don’t do that. Keep your voice down. That’s a very reasonable thing to ask of people in these public spaces. But I’m for giving and taking. We should take away from people this freedom they might feel to chat loudly on the phone in CVS and Trader Joe’s, while at the same time giving them the removal of outdoor mask mandates. [We should be] giving them the outside, not shutting down beaches [or] shaming people for going out in a park without their masks on. We should be celebrating the outdoors, while more tightly regulating the indoors. Hamblin: I couldn’t agree more with you, Derek. This is an issue that, in covering health behaviors, I tend to run up against quite a lot. People see binaries. Something is either good or bad. And masks seem to fall in that category where it’s hard to emphasize that things are only good or bad in context. How do you think about threading that needle for people who are just like: I thought I needed to wear a mask. Now you’re saying I don’t need to wear a mask? I think Dr. [Anthony] Fauci sees that binary and thinks: We need to keep people in the “Masks are good” category and not the “Masks are bad” category. Thompson: Masks work, period. But they’re not doing that work when you’re outside and alone. Seat belts work, period. Are seat belts doing any work when you’re sitting in a parked car in a parking lot? So it doesn’t make any sense to write local ordinances that say people in parked cars must have their seat belts on. That’s how I feel about masks. I think the public can take a little bit more nuance. Hamblin: Yeah, I hear you. Masks are good and seat belts are good. But if you blend either of them up into a smoothie and drink them, that’s not good. Thompson: Yes, good things out of context can be pointless, especially if you blend them into smoothies. from https://ift.tt/2QpJhuf Check out http://natthash.tumblr.com If the immune system ran its own version of The Bachelor, antibodies would, hands down, get this season’s final rose. These Y-shaped molecules have acquired some star-caliber celebrity in the past year, due in no small part to COVID-19. For months, their potentially protective powers have made headlines around the globe; we test for them with abandon, and anxiously await the results. Many people have come to equate antibodies, perhaps not entirely accurately, with near imperviousness to the coronavirus and its effects. Antibodies are, in many ways, the heartthrobs of the immune system—and some 15 months deep into immunological infatuation, the world is still swooning hard. Frankly, it’s all getting to be a little too much. Don’t get me wrong: Antibodies have served me well, and thanks to my recent dalliance with the Pfizer vaccine, the anti-coronavirus variety will be receiving an extra dose of my admiration for a good while yet. I am, above all else, eager for the rest of the global population to nab the safeguards they offer, ideally for keeps. But antibodies are simply not the only immune-system singles worthy of our love. A multitude of cells and molecules are crucial to building a protective immune response against this virus and many others. It’s time we took a break from antibodies, and embarked on a brief Rumspringa with the rest of the body’s great defenders. What follows isn’t even close to a comprehensive overview of the immune system, because I am not a masochist, and because no one wants to read a 75,000-word story. Instead, I asked a few immunologists to chat with me about some of their favorite immune cells and molecules, and imagine what these disease fighters might be like if they truly were single and ready to mingle. As it were, everyone needs someone to be their starter bae. Some good candidates might be found among the members of the innate immune system, a fast-acting fleet of cells that are the first to contend with an infection. (Antibodies belong to another branch, called the adaptive immune system; more on that later.) They’re a lot like adolescent lovers: dogged and earnest, but impulsive and, on occasion, woefully imprecise. Unlike antibodies, which can zero in on specific pathogens, innate immune cells are built to clobber just about anything that doesn’t resemble their human host. Perhaps it’s no surprise that these underdog cells are often forgotten or outright snubbed in conversations about immune protection. But the all-purpose approach of innate immune cells has its charms. They’ll try anything at least once, and they’re admirably selfless. When pathogens come knocking, innate cells are the first to volunteer to fight, and often the first to die (RIP, neutrophils). Some ambush invading microbes directly, snarfing them down or bathing them with deadly toxins, while others blow up infected cells—tactics reminiscent of guerrilla warfare. Although antibodies take many days to appear, innate cells will immediately be “by your side when you have a problem,” Ashton Trotman-Grant, an immunologist at the University of Toronto, told me. These acts of martyrdom buy the rest of the immune system time to prepare a more targeted attack. And in many cases, innate immune cells act so quickly and decisively that they can subdue an invasive microbe on their own—a level of self-sufficiency that most other defenders can’t match. Some innate immune cells are also just plain adorable. Among the fan favorites are macrophages (“big eaters” in Greek), aptly named for their round-boi physique and insatiable appetite. Their goal in life is to chow down for the greater good. “They’ll never make you feel like you’re eating too much, and they’re open to trying new foods,” Juliet Morrison, a virologist and immunologist at UC Riverside, told me. They’re also endearingly unselfish: If a microbe crosses their path, they’ll gobble it up, then belch up bits to wave at adaptive immune cells as a warning of potential danger. It’s a great gift-giving strategy, Morrison said, especially if weird microscopic puke is what makes your heart go pitter-patter. Dendritic cells have a similar modus operandi. Like macrophages, they specialize in regurgitating gunk for other immune cells. But they are much more social than macrophages, which prefer to gorge and digest in solitude. Dendritic cells are sentinels and gregarious gossips; their primary imperative is to “talk and hang out with other cells,” and they’ll flit from tissue to tissue to do it, David Martinez, an immunologist at the University of North Carolina at Chapel Hill, told me. If you’ve recently caught word of a new and dangerous infection, you probably heard about it from a dendritic cell. A few weeks ago, Trotman-Grant put together a March Madness–style bracket to choose the “best” immune cell; after a couple of grueling weeks of voting, dendritic cells won. They’re almost certainly the cells you’d want to take to prom. But Trotman-Grant warned that their social-butterfly tendencies could be a double-edged sword: Dendritic cells just aren’t the type to settle down. Innate immune cells might be convenient dates, for a time. But while they’re great at first impressions, they can also be commitment-phobes, as likely to ghost you as they are to come on strong. (Besides, who wants to date someone who’s always arriving on the early side?) The real keepers belong to the adaptive branch of the immune system: B cells—the makers of antibodies—and T cells, which, among many other tasks, kill virus-infected cells. Adaptives are slow-moving specialists. They take down microbial invaders that innate cells can’t handle on their own, relying heavily on intel from macrophages, dendritic cells, and other early defenders. They won’t be the first to make a move, but they’re sharp and sophisticated, capable of singling out individual pathogens and zapping them with precision. B and T cells are self-assured enough to know what they want. Unlike innate cells, they’re also capable of remembering the things they’ve encountered before, ensuring that most pathogens can’t trouble the same person twice; that capacity is the conceptual basis of vaccines. “They do a great job at committing things to memory,” Ryan McNamara, a virologist at UNC Chapel Hill, told me. That also means no missed birthdays or anniversaries—and no chance they’ll ever forget that time you were wrong. If you’re a fan of antibodies, you have B cells to thank: They are the glorious wellsprings whence these molecules hail. (On Mother’s Day, antibodies call their B cells.) Unfortunately, B cells are often overlooked; as living, dividing cells that hide away in tissues, they’re harder to isolate and study than the proteins they produce. But the antibodies they deploy can be powerful enough to quash microbes before they break into cells, potentially halting infections in their tracks. And even after antibodies disappear, B cells persist, ready to produce more. Martinez stans the B cells he studies. But he’s wary of their romantic potential. B cells, he said, are almost too good at their job, and will compete aggressively among themselves. Their crime-fighting careers consume them, leaving little room for a fulfilling personal life. “I would say B cells are selfish,” he told me. In the cold light of morning, it turns out a lot of them are just self-involved snobs. T cells play a far more subtle game. Their career choices range from demolishing virus-killed cells to corralling and coordinating other immune cells. As several researchers have pointed out, T cells might be some of the most underappreciated cells in the war against COVID-19, especially when it comes to vaccines. Some evidence even suggests that, in the absence of decent antibodies, T cells can clean up the coronavirus mostly on their own. Certain T cells are killers. As their name suggests, they operate with devilish flair: When they happen upon virus-infected cells, they force them to self-destruct. Killers’ excellent memories also give them a predilection for grudges—enemies that trouble them twice should expect to be trounced with extra gusto. Thrill seekers might be drawn to killers, but Avery August, an immunologist at Cornell University, points out that these cells, also called cytotoxic T cells, might be all take and no give. Scientifically, they’re full of intrigue; romantically, he told me, “not so much”—at least for him. Then there are the helpers—the benign Jekyll to the killers’ bellicose Hyde. Helper Ts are some of the most loyal partners you’ll find in the immune system, nurturing almost to a fault and versatile to boot. They coax B cells into maturing into antibody factories. They cheer killers along their murderous paths. They even goad innate immune cells into becoming the most ferocious fighters (and feeders) they can be. Effectively, helpers are “badass multitaskers that coordinate every level of immunity,” Marion Pepper, an immunologist at the University of Washington, told me. They’re about as supportive as they come—as long as you don’t mind being micromanaged from time to time. It’s easy to see the appeal of antibodies. They’re among the few immune-system soldiers that can annihilate viruses before they enter cells, and they’re thought to be crucial to most vaccines. They can also be team players, throwing up red flags around microbes in order to alert other defenders to their presence. Transferred from animal to animal, or human to human, antibodies can confer protection against COVID-19; synthetic versions of the molecules are also relatively straightforward to manufacture en masse. Scoring a date with an antibody is a bit like finally getting together with the most popular person in school. But counting on antibodies, and only antibodies, for protection is like shacking up with the first eligible suitor you meet—a risky and perhaps close-minded gamble. In the same way that our immune systems can guard against multiple pathogens at once, we could stand to be a bit less monogamous with our affections. Besides, the choice might not ultimately be ours to make. Love is a two-way street, and antibodies are incorrigibly picky. Their sole mission is to glom on to a very specific microbe and cling to it, ignoring everything else along the way; it’s largely them doing the picking and choosing. And if you’re not the soul mate they imagined, there’s little you can do to change their minds—they’re proteins, and they don’t have one. Really, it’s not them. It’s you. from https://ift.tt/2QhBvmk Check out http://natthash.tumblr.com |
Authorhttp://natthash.tumblr.com Archives
April 2023
Categories |